Inflammation in the joint of the big toe | Inflammation in the big toe

Inflammation in the joint of the big toe

Often the cause of an inflammation in the big toe is that the nail or components of the nail bed or cuticle are inflamed. These inflammations can be limited to the nail wall, for example, but they can also reach deep into the nail bed or cuticle and cause an abscess. Very often ingrown toenails (Unguis icarnatus) are the cause of recurring inflammation such as panaritia or paronychia.

These can occur more frequently in families or can be caused by wearing too tight shoes or by incorrect nail care. The fact that the nail grows into the nail bed results in painful inflammations and small wounds, through which germs can migrate into the tissue. Another cause of inflammation of the nail or the nail bed are small wounds on the nail wall (also called nail fold).

Through these small wounds, especially skin germs such as Staphylococcus aureus enter the tissue and cause an infectious inflammation there. Depending on which part of the cuticle or the deeper tissue is affected, one speaks of onychia, paronychia or panaritium. For small, localized inflammations, local therapy with an antiseptic or antibiotic ointment and cooling bandages is usually sufficient. Deeper inflammations are relieved with an incision, so that the pus can flow off (drainage). In case of systemic symptoms such as fever or an imminent spread of the inflammation, antibiotics are additionally administered.

Therapy for inflammation in the big toe

The therapy of an inflammation of the big toe depends on the underlying cause. Frequently, cooling and elevation of the affected toe provides initial relief for those affected. In the case of an infectious inflammation of the nail bed or the deeper tissue (paronychia or panaritium), the therapy depends on the extent of the finding.

A mild and locally limited inflammation can be treated with an antiseptic ointment or with antibiotics. In case of a fungal infection, antimycotic ointments are applied. However, if a more extensive inflammation, an abscess or even systemic symptoms such as fever have already occurred, the inflamed area is cut open (incision) and drained.

This means that existing pus is removed. Swabs are also taken to determine the pathogen. If dead tissue or an ingrown toenail is present, it is also removed.

The toe is then immobilized. In case of a deep infection and systemic symptoms such as fever, antibiotics are also administered. Inflammation due to gout, on the other hand, is treated quite differently.

In this case, this acute attack (Podagra) results from the deposition of uric acid crystals in the metatarsophalangeal joint of the big toe. It is treated acutely with so-called NSAR (non-steroidal anti-rheumatic drugs). These are anti-inflammatory and analgesic agents such as Diclofenac and Indometacin.

Furthermore, glucocorticoids (prednisolone) are administered. Since both drugs together can damage the stomach, stomach protection such as omeprazole is usually also administered. Colchicine serves as a reserve medication.

The toe is also cooled. In order to prevent such attacks of gout from recurring, long-term therapy is then indicated, which in symptom-free patients includes dietary measures (low meat diet, reduction of body weight, reduction of alcohol consumption, adequate fluid intake). In patients with recurrent attacks of gout, the drug allopurinol is also used.

The therapy of rheumatoid arthritis comprises a number of different measures. In acute attacks, pain-relieving drugs such as NSAIDs are also administered. Cooling of the toe also helps.

In long-term therapy, there is a large number of drugs that are used. These include basic therapeutics such as methotrexate or biologicals such as Infliximab. In addition, in rheumatoid arthritis, movement therapy approaches such as physiotherapy are also very important.

Ointments can usually provide relief from acute inflammation. Sometimes they can also lead to a healing of the inflammation. In the case of acute pain, for example in the context of gout, a cooling ointment can alleviate the pain.

Infectious inflammation is often treated with antiseptic and antibiotic ointments. The antiseptic component cleans and disinfects the affected area, whereas an antibiotic agent additionally combats the bacteria that cause the inflammation.However, such ointments can only lead to healing if the inflammation is locally limited and has not spread to the depths or even led to a systemic disease. Nevertheless, they can be used in conjunction with surgical or systemic therapy.

There are various antibiotic wound ointments, some of which are available without a prescription. It is best to consult a doctor and a pharmacist regarding dosage and application. Ointments containing the active ingredients fusidic acid or retapamulin are often used for local application.

Furthermore, an antiseptic ointment with the active ingredient povidone-iodine is often used. Examples are Betaisodona or Braunovidone ointment. In case of a fungal infestation of the big toe, antimycotic tinctures or ointments are applied to fight the fungus.

Active ingredients contained in these ointments are, for example, Nystatin or Naftifin. There are also ointments that are used to support healing and alleviate the symptoms. These include ointments with the active ingredient ammonium bituminosulfate (also called ichtyol), which is sold under the trade name “Schwarze Salbe Lichtenstein”.

Another over-the-counter ointment that is often used to alleviate symptoms is Medice® Brand and Wound Gel. It also has a cooling effect and supports healing. There are many other ointments that are very similar in composition to the ointments already mentioned.