Toes are like pepper

We can move freely, and the role of the feet is crucial. Due to the high frequency, there are more problems with the feet, but some are difficult to understand. For example, the toes hurt like they are coated with chili peppers. There are many possible reasons. Purulent dactylitis, paronychia, gout, etc. have similar pains. The key is to understand the situation so that you can determine the solution later.

1. Purulent dactylitis

Purulent dactylitis refers to a purulent infection of the subcutaneous tissue at the base of the fingertips. It is often caused by minor injuries or foreign bodies followed by bacterial infection, with the main pathogen being Staphylococcus aureus.

Local pain is the main symptom. At the beginning, it is mostly a tingling pain. As the local inflammation worsens, the pressure in the space between the fingertips increases, and local severe pain occurs. When the digital arteries on both sides of the fingers are compressed, pulsating pain may occur. When the hands are lowered or the fingertips are tapped, the pain becomes more severe due to the increased pressure, which is often unbearable for the patient. The patient often cannot sleep at night due to the severe pain. The fingertips may be red and swollen, but it is usually not obvious; as the pressure in the subcutaneous cavity of the fingertips increases, blood circulation disorders occur and the fingertips may appear yellow-white. If not treated promptly, chronic osteomyelitis may develop. Purulent dactylitis is often accompanied by varying degrees of systemic infection and poisoning symptoms, such as fever, fatigue, loss of appetite, etc., and a routine blood test may show an elevated white blood cell count.

2. Paronychia

Paronychia is mostly caused by punctures, abrasions, ingrown nails or pulling out "inserted skin thorns" of the nail groove and surrounding tissues. Subungual abscess is often caused by the spread of paronychia, infection caused by subungual puncture, or secondary infection of subungual hematoma caused by fingertip compression injury. The main pathogen is Staphylococcus aureus.

At the beginning, one side of the nail groove will become red, swollen and painful, and it may become purulent and infected within a short period of time. It may spread to the base of the nail and the opposite nail groove, forming perionychia, or it may spread to the subungual area to form a subungual abscess. At this time, the pain intensifies and the swelling is obvious. Yellow-white pus can be seen under the nail floating up the nail. If not treated in time, it may develop into purulent dactylitis and even cause phalangeal osteomyelitis. It may also become chronic paronychia, persistent paronychia or subungual abscess. Because the infection is relatively superficial, the systemic symptoms are often not obvious.

3. Gout

Gout is a crystal-related arthritis caused by the deposition of monosodium urate (MSU), which is directly related to hyperuricemia caused by purine metabolism disorders and/or decreased uric acid excretion. It specifically refers to acute characteristic arthritis and chronic tophi disease, mainly including acute onset arthritis, tophi formation, tophi-induced chronic arthritis, urate nephropathy and uric acid urinary stones. In severe cases, joint disability and renal insufficiency may occur. Gout is often accompanied by abdominal obesity, hyperlipidemia, hypertension, type 2 diabetes and cardiovascular disease.

Most patients have no obvious signs before an attack, or only experience fatigue, general malaise, and joint pain. A typical attack often begins with awakening the patient in the middle of the night due to joint pain. The pain progressively intensifies, reaching a peak in about 12 hours, and feels like tearing, cutting, or biting, which is unbearable. The affected joints and surrounding tissues are red, swollen, hot, painful, and have limited function. Usually resolves spontaneously within a few days or 2 weeks. The first attack often affects a single joint, some of which occur at the first metatarsophalangeal joint. Later in the course of the disease, some patients also have involvement of this area. The next most common joints are the dorsum of the foot, heel, ankle, knee, wrist and elbow. The shoulder, hip, spine and temporomandibular joints are less frequently affected. Multiple joints may be affected at the same time, manifesting as polyarthritis. Some patients may have systemic symptoms such as fever, chills, headache, palpitations and nausea, which may be accompanied by increased white blood cell count, increased erythrocyte sedimentation rate and increased C-reactive protein.