Question: Sir, as u can see in the image that my left toe get swelled, blackish and painfull whenever I stretch it or press it the affected area (below nail & side portion). I consulted Physician, he conducted blood tests & uric acid test which was (both report) found normal, my uric acid level was 4.65 mg/dl. I also done xray report says “no fracture & Soft tissue swelling seen”. Dr gave me some antibiotics (Declofenec, Lucipro-500, Lodiric) for 01 week. No substantial improvement. Sir, I want to ask what the diseases is & its cause as I m little worried & irritated as the problem suddenly developed. I can also confirm that this not due to any past injury. The problem is continuing from more than 1 month. Also advice to whom I should consult whether any physician or specialized doctor
Brief Answer:
Follows.
Detailed Answer:
Dear Sir,
Thank you for posting your query on HCM.
Well looking into your problem I would like to tell you that there are a lot of things that favour gout as the diagnosis . Males , the swelling of left toe and non traumatic onset .
Other things that I would like to know is about your alcohol intake , and whether it is your big toe that is involved . It is not essential that uric acid be raised at the time of acute attack .It is maximum times based on clinician assessment .
Other possibility is infection for which you have already take the antibiotic course . It is advisable to you to see a rheumatologist for this .Till then you can take naproxen 500 mg twice a day after consulting your treating doctor if there is no contraindication.
Take care.
Dr. Shruti
Follow up: Dr. Dr. Shruti Rijhwani (18 hours later)
Mam i appreciate your reply. With regard to your query i tell u that i am complete non alcoholic and presently problem occurred in my left toe only (as u have seen in image). Mam r u completely ruling out gout or infection?As i had suffered some infectious disease after surgery like phlebitis in my right arm. Right now i am ok. Pl also tell about rheumatologist as probably i wont get in my city Siliguri. Whether its a part of orthopaedics deptt. Only orthopaedics will be available in my city.
Brief Answer:
Follows.
Detailed Answer:
Dear Sir,
Your photograph that you are mentioning of the toe is not available or uploaded , can you do that so that I can see it .
Dr. Shruti
Follow up: Dr. Dr. Shruti Rijhwani (47 hours later)
mam i have uploaded two images. If u not been able to see it then pl furnish alternate mode of sending it (either any email id). untill u don't see it, probably u will not be able reach at conclusion and thereafter necessary advice. Still i have taken 03 doses of naproxen-500, got some relief, reduced some pain & swelling, but didn't eradicate the problem completely. Affected area is still blackish. Waiting for your valuable advice based on your latest observation. Still i have to consult rheumatologist?(Provide the doctor's name in Siliguri city, if u have)
Brief Answer:
Follows.
Detailed Answer:
Dear Sir,
Looking at your toe it does not seem like gouty arthritis it looks more like infective particularly at the nail bed . Since you have completed a course of your antibiotic it may settle down on its own . I think you can take naproxen for two more days . You should see a physician for this and continue in his advise.
Dr. Shruti
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What Causes Swelling And Pain On Toes?
Brief Answer:
Follows.
Detailed Answer:
Dear Sir,
Thank you for posting your query on HCM.
Well looking into your problem I would like to tell you that there are a lot of things that favour gout as the diagnosis . Males , the swelling of left toe and non traumatic onset .
Other things that I would like to know is about your alcohol intake , and whether it is your big toe that is involved . It is not essential that uric acid be raised at the time of acute attack .It is maximum times based on clinician assessment .
Other possibility is infection for which you have already take the antibiotic course . It is advisable to you to see a rheumatologist for this .Till then you can take naproxen 500 mg twice a day after consulting your treating doctor if there is no contraindication.
Take care.
Dr. Shruti