Does this sound like an ingrown toenail? Severe toe pain in joint.

[NorwichMom]

I have had severe big toe pain since March. I have been to the GP 3 x so far. And she doesn’t seem sure what it is. She said it might be an infection and prescribed antibiotics. They didn’t help. Then said it could be a fungal infection and prescribed ointment which hasn’t helped. I’ve had an x-ray which shows mild arthritis at the joint where the toe meets the foot but it doesn’t hurt here.

There is no redness or swelling. It doesn’t look like a fungal nail. Then last time she said maybe it’s an ingrown toe nail. It hurts so much i can’t look. She’s looked a bit while I tried not to scream but didn’t seem sure. I’m now painting some ingrown toe nail stuff on my nail, so far that’s not helped. I also soak my foot in salt water most nights.

the pain is on the top of my toe, mainly focused around the top of the joint nearest the nail. If I press lightly on top of the nail it hurts a bit. If I press at the side of the nail it doesn’t hurt. If I touch the top of my toe further back from the nail it can literally make me scream.

i have to brace myself to put a pair of trousers on as the pain of the material touching my toe is excruciating. Sleep is difficult as the weight of the duvet is awful. I can’t sleep on my stomach with the top of my toe touching the mattress either. I wore a long skirt the other day and open toe sandals, a lightweight silk skirt and I screamed when it brushed across the top of my toe.

GP has said twice now maybe it’s an ingrown toe nail but to me where the pain is doesn’t seem to fit. And I’ve told her this and she doesn’t seem to listen but also admits she’s a bit stumped. Can an ingrown toenail cause the main focus of the pain to be in the joint and not near the nail? It hurts if I scrunch my toes up.

when I first saw her back in March I said I thought it might be gout but she said there’s no redness or swelling.

I broke my back once and my toe hurts more than that did. Will check the diet out, thanks.

I’d be very surprised if it is an ingrown toe nail given the rest of the info you have given - pain in toe joint, back pain, frozen shoulder and tendon problems.

Any history of psoriasis in your family? Any slight changes on nails, bad cases of dandruff?

Sacroiliac pain, toe problems and tendon issues are hallmarks of psoriatic arthritis and you can get it without having psoriasis or have psoriasis without realising it eg. Appearing to have a sweat rash under breasts, bad case of dandruff. My Dad had his one and only bit on leg age 84 shortly before he died and to my surprise my brother also has it and my aunt and cousin.

I was refused referral to rheumatology on NHS. Paid for private one who sent for MRI scan. He said no active inflammation on SI joint, and diagnosed hip and osteoarthritis.

Eventually went to another private rheumatologist who ordered the MRI scan be sent up and said although no active inflammation it showed old inflammation in SI. Prodded all my joints and assessed for swelling, took family history and I walked out with a psoriatic arthritis diagnosis as I knew I would (ironically I spent a couple of years doing research in a rheumatology department).

Am now on NHS and transferred hospitals and get decent treatment but have been quite resistant to treatments, I think as it took so long to be diagnosed. The inflammation destroyed a third of the head of my hip of the hip with dysplasia so had to have a new one and one toe is now deformed. I’m on my second biologic and hoping it will work.

There are rheumatologists and rheumatologists. Was reading on a FB group someone who was diagnosed with PsA some years ago and on meds. Current rheumatologist (actually a GP with and interest in rheumatology ) is saying as no active inflammation she doesn’t have it and is taking her off her meds.

If you can afford it at this point I would find a decent rheumatologist and go privately, decent being the key word. Sorry for essay. Hope there is something helpful in it.

@Seaitoverthere thanks for all that information. I do feel there’s something else going on. I did actually pay last year to see a private rheumatologist and she was awful. She was the one who wrote untrue information that I’d never had tendon problems after I told her I did and said I can’t have AS if there is no changes in my SI joints. My dad was riddled with autoimmune stuff but not Psirosis that I know of, he had Wengers Granulosum or however you spell it. The rheumatologist did ask if I or any family had psirosis.

sorry you had to fight so hard for a diagnosis.

Thanks @NorwichMom . I think given your family history of autoimmune disease something is going on. So sorry you too have had a crap private rheumatologist.

Can I suggest that you join some Facebook groups for AS and PsA and see if you can get some recommendations for another rheumatologist? You shouldn’t have to but at this point I think it would be sensible. A fresh pair of eyes on the scan may come to a different conclusion as happened with my scan. I said to her not to bother ordering the film as he had looked at it but thank goodness she did, she is great and has a lot of people coming for second opinions.

You have my deepest sympathy. The pain is horrible, before meds it used to stop me sleeping.

How does a GP see these symptoms and not order a gout blood test?! FFS
I'm wincing to think of the pain you must be in if it is.

gout?

Yes, sounds like gout to me too.

Blood results are all normal. No inflammation and no raised urea. So not gout and not inflammatory arthritis I guess. Unless it’s psiortic (sp) arthritis? 🤷🏻‍♀️

think I’ll have to see a podiatrist next. Rule out a toenail problem

Money. The nhs is a dying breed and now there’s restrictions on what blood tests are deemed necessary and not (according to middle management I’m assuming). I think the pp was right who said it sounds like a immune disorder of some sorts

See a podiatrist but find a decent one who has ultrasound machinery and can do operations. (I first saw one who couldn't do this and even totally misdiagnosed my gait, though they are good for actual ingrown toenails.).
The ultrasound should be really useful for diagnosis.

Honestly - seeing a chiropodist would have been the first thing I did!

Trying to find a private chiropodist now, the ones I've rung so far are booked till August. Obviously a profession to get into!