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T Khan
T Khan, Doctor
Category: Medical
Satisfied Customers: 1097
Experience:  UW Med School/UCLA Training/USC Faculty. Full Spectrum Family Medicine - Adult, Peds, OB/GYN
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What can cause stabbing pain in the big toe?

Resolved Question:

I have stabbing pain at the end of my right big toe. The pain feels like an ice pick being pushed into the tip. It has happened 3 times in last two 2 weeks, and has woke me up once, and twice while sitting. Also, have pulsing vibration on side of left foot and 3rd-5th toes. Vibration is mild, approx 1/2 as fast as heart beat, only noticeable when seated.

Submitted: 7 years ago.
Category: Medical
Expert:  T Khan replied 7 years ago.

Welcome to JA - sorry you are going through this.
Do you have any medical problems or take any medications? Other symptoms? Is it swollen or red?

Customer: replied 7 years ago.

No edema or erythema. Histroy includes: mild scoliosis, mild osteoarthritis, Gerd & IBS controlled by diet & Prilosec, possible lactose intolerance, depression controlled by Prozac, osteoarthritis controlled by Ca+D and Fosamax. I am an RN. Exercise regularly walking & weight machines, height 5'5'', weight 140. Frequent neck pain: use heat, Tylenol, occasionally Skelaxin, nonsmoker, glass wine 2-3 times weekly.

Expert:  T Khan replied 7 years ago.

Great - thanks for that info.

As a RN, I'm sure you know that all small joint arthritis has to be ruled out for auto-immune arthritis. Thus, before anything else, you need an ANA/ESR/CRP to rule out this.

Next, there aren't many other causes of small joint arthritis.

1) osteoarthritis --> not likely given the time frame

2) osteomyelitis --> not likely if you have no signs of infxn

3) Gout --> possible. You should get a blood uric acid level and joint tap.

4) Pseudogout --> Very possible given the situation above and a joint tap is the best way to know this.


Treatment of gout is multifold: 1) what a doctor can do for a patient and 2) what a patient can do for themselves.


1) What a doctor can do for a patient

- Acute flare:

- colchicine

- naproxen or indomethacin

- Vitamin C 8 grams daily for 3 days

- Rest

- Ice

- Elevation


- Chronic preventative management:

- vitamin C 1500 mg daily

- allopurinol

- Diet


2) What a patient can do for themselves:


Very high purine content.
Herring, herring roe, meat extracts, mussels,
Sardines, yeast (brewer's and baker's).
Alcohol : Alcohol contains no purine but interferes with uric acid excretion.

High purine content - not more than one item once a week.
Anchovies, bacon, chicken soup, Beef, mutton leg, mutton chop, pheasant, salmon, sausage, trout, turkey, veal, venison, lobster, crab.

Moderate purine content-not more than one item 4 times a week.
Asparagus, bass, bouillon, brains, cauliflower, chicken, duck, halibut, ham, kidney beans, lentils, Lima beans, liverwurst, mushrooms, oysters, peas, plaice, pork, rabbit, roe, shad, spinach, tongue, tripe, tuna, wholegrain cereals and bread.

Low or no purine content - as often as desired.
Beverages -tea, coffee, cocoa, chocolate
Carbonated soft drinks
Fruit juices
Sugar, sweets
Vegetables : (except those under BE CAREFUL)
Vegetables and cream soups (no meat stock)
Butter, fats of all kinds (in moderation)
Bread (except wholegrain)
Cereals (except wholegrain)
Cheese : all kinds (in moderation)
Milk - buttermilk, condensed, malted
Nuts - all kinds, peanut butter

Drink plenty of water (2-3 litres per day) to help flush uric acid through the kidneys. Please note - if you have cardiac or kidney disease, your doctor may actually require fluid restriction - and you should consult him regarding fluid intake allowance.
Keep dietary fat to a minimum.

Be careful not to damage the joint.

Take your prescribed medication regularly.



Read here for Gout information:



Hope this helps and good luck to you!

Customer: replied 7 years ago.
The pain is not in the joint. It is stabbing pain in the very tip of my great toe. It is a very different pain than my osteoarthritis.
Expert:  T Khan replied 7 years ago.

I see - that makes a neruopathy more concerning or a problem with the nail bed.

You will need the nail examined of course but the other thing you may want to consider is a platelet/coags/and workup for vascular disease to make sure this isn't from micro vascular disease.

Otherwise, you may want to consider a trial of lyrica or neurontin. Does this help?

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