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Forum Name: Rheumatology Topics

Question: Foot pain with swelling on top of foot.


 kcornall - Mon Jan 24, 2005 11:15 pm

I have been having pain on 3 occasions on my right foot. I have not found a reason for this yet but it subsides after 4-5 days of limping around on it. The pain is localized on the top of the foot, near the center of the foot, between the large toe and the one next to it. I thought I had broken something in the foot, but last week, my left foot had the same problem (pic enclosed).

Help????

With my second onset, I had a blood test (thinking it was gout). Called the office 3 days later and they said it wasn't gout.
 Dr. Anthony Solomon - Tue Jan 25, 2005 8:29 pm

Without examination, and in the absence of injury, it is difficult to suggest a cause.
It is however necessary to exclude gout which typically affects the small joints of the feet, especially the joint of the big toe, or the arch of the foot. It usually presents with acute onset of pain, with swelling and tenderness, frequently at night, without any apparent precipitating cause or following alcohol excess or certain medications.

More than one joint may occasionally be affected during the same attack and you infer that in your complaint.

It is advisable to consult your physician for estimation of your fasting uric acid level, white cell count and sedimentation rate.

I hope this information is helpful.


Dr Anthony Solomon
MB BS DTM&H DIP.VEN FRSM
 kcornall - Sun Feb 13, 2005 2:11 pm

I was tested for gout after the second bout on my right foot. Test was O.K. I finally got in to my primary physician (of corse after my foot got better) and I still had a little tenderness when he pushed hard between the big toe and the next one on the top of the foot. They are going to refer me to a podiatrist but have not got the appointment yet. My foot is fine as of now. Until next time......
 Dr. Anthony Solomon - Sun Feb 13, 2005 7:05 pm

It is important to note that a single uric acid determination may be normal in 25% of cases of acute gout, so one normal uric acid measurement does not exclude gout. Therefore, it is essential to have serial measurements during the course of an attack.

The uric acid level is elevated in 95% of patients who have serial estimations during the course of an attack. Please keep this in mind if you do suffer another attack.


Dr Anthony Solomon
 nike9123 - Fri Jul 29, 2005 11:03 pm

For about a week now I have been experiencing pain in my right foot. It is noticably swollen on the top of my foot, near the third and fourth toes. I have tried icepacks and that didn't seem to work. Putting my foot in hot water didn't work. I thought it would go away by now, but it isn't but it also doesn't seem to be getting worse. I have looked up possibilities such as foot tendonitis, it sounds like it could be it...what about Carpel Tunnel (or however it is spelled) I am on my feet all the time. Please help :)
 hancor - Thu Jan 08, 2009 2:52 pm

I have this exact issue happening with me and it has been happening for the past 8 years. No one has been able to tell me what it is. It just happen to me when I was in excellent shape. Now after 8 years I went from 200 lbs to 300 lbs and during the 8 years I have had two doctors tell me that I have gout and that now they don't think I have gout. I am going to a gastrologist now because my doctor has referred me to one of them because of my fatty liver. He has tested me for all kinds of liver diseases and nothing has come back that is related to this foot pain. My doctor said I need to get my liver healthly first before he can handle my foot pain. He said he needs to know that the two are not related.

Any ideas from anyone? Any other type of doctor I should be seeing?
 Tom Plamondon PA-C - Fri Jan 09, 2009 12:48 pm

User avatar Thanks for the question.

I see the only connection between the fatty liver disease and the foot pain is if you have a history of alcoholism or alcohol abuse. Alcohol can worsen gout and of course can cause liver damage.

Arthritis in the feet can have several causes:
gout
septic (infection) arthritis
osteo arthritis
rheumatoid arthritis
inflammatory bowel disease
psoriatic arthritis (usu have a hx of psoriasis - but not always)
Reiters syndrome (classically will see urethritis and conjunctivitis too).

Of course not all foot pain is arthritis. Nerves, tendons, ligament and blood vessels all run throughout the foot and can be inflamed, infection, swollen, etc.

I trust that you and your physician will be able to work through this. A podiatrist may help if the foot pain continues.

Keep us posted and let us know how things turn out.
 hancor - Fri Jan 09, 2009 2:12 pm

I do not drink so that helps rule that out. My pain doesn't feel like joint or bone pain. I do have swelling in my ankles though when it happens. Not a lot of swelling but some. Also, it doesn't always happen in the same foot, even though my left foot usually is the one to hurt. I've never had an injury on my feet during my high school days in sports or anytime outside of that. You mentioned nerves. I randomly have my feet go to sleep even during these attacks and sometimes sleeping. Could it be caused by poor circulation?

On the tendons and ligament subject.
I did have ankle sprangs during sports when I was younger. Could there have been damage to tendons or ligament during that time that randomly just acts up on me?

My condition started this way: 200 lbs 6'2" 1. I wake up in January of 2000 on morning to this pain in my feet. Not just one of my feet, but both. I had to walk on the outsides of my feet just to move around. I stayed in the bed for 2 days and then the pain went away.

2nd attack started exactly one year later to the month. Same exact thing. I stayed on my feet for 2 days and then it went away.

Next attack came upon me just 6 months after the second attack. 6'2" 240 lbs.

After this point I started loosing track of my attacks because they come too often now. I get them 2-3 weeks apart now. Now I weigh 300lbs. I'm sure the pain coming so offen now has to do with my weight gain. I'm still on day 2 waiting for a gastrologist to contact me. No luck so far! ;(

Is there anyone that is close to the Dothan, Alabama area on these forums? or someone that you can recommend to me in this area or even close to my area. I'm tired of living with this condition that no one can help me with. I want to get out there and find help and I would be willing to travel around AL, GA, FL, etc. to find some expert help.
 Tom Plamondon PA-C - Wed Jan 14, 2009 9:58 am

User avatar Hello,
Bilateral foot edema can be caused by arthritis, poor circulation (poor venous return), or heart failure.
Your physician can best determine the cause with a thorough history and physical.

Why did two doctors say you had gout and then one doctor say you did not?
How did they come to their conclusions: were you uric acid levels high, were there urate crystals in the fluid aspirated from the joint? what did the xrays show?
Bilateral foot swelling leads one to believe the cause is not gout.

Regarding the liver: sounds like this might be non-alcoholic fatty liver disease (aka NASH). Treatment is conservative: weight loss, low fat diet, vaccination against Hepititis A and B, avoiding medicine through could cause liver toxicity (acetaminophen, statins).

Let us know how it turns out with your feet.
 maq - Mon Apr 20, 2009 11:16 pm

helloz Sir,

i do hv a prblm of foot swelling.i dun hv any other problem like bout or uric acid.due to swelling in foot i had pain in legs under knee. will u please suggest me wot should i do??

i didnt consult any physician yet.
 thehunter - Sun Apr 26, 2009 9:07 pm

Hi i am a male 16 year's of age and i have a dark lump on the top of my left foot near the fourth toe.i have had the lump for about 11 months and it is starting to concern me.I got it from when my baby brother was learning how to walk he kept stepping on my foot severel times with his hard shoe's.The lump only gives me pain wen pressure is on it or sometimes it just start to hurt when im just sitting.For now it doesnt do it but it comes back and fourth.Im wondering what it could be?

Thank you
 Tom Plamondon PA-C - Tue May 05, 2009 9:48 pm

User avatar Dear Maq,

Unilateral foot swelling can be caused by trauma, infection, inflammation, poor circulation, or referred pain from the back. So...

Seeing a physician for a complete history and physical would the next right step to review all the needed questions and exam / testing needed.

If you have any additional info on the foot swelling (how long has it been there, sudden vs gradual onset, any pain, any trauma, etc.) I may be able to suggest a few possible diagnoses.

Take care.
 Tom Plamondon PA-C - Tue May 05, 2009 9:51 pm

User avatar Dear TheHunter,

A painful dark nodule from trauma 11 months ago reminds me of an unresolved hematoma which may need to be lanced and drained. I would also do an xray of the bone to make sure there is no fracture.

In either case, seeing a physician would help to accurately diagnose and treat the problem.

Take care.

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