Discomfort in My Right Big Toe and Now Pain in My Left Knee
I'm a 40-year-old woman, and approximately a month ago, I experienced a sudden shooting pain in my right big toe. By the time morning arrived, the pain diminished to a persistent dull ache, which has been bothering me on and off for several weeks now. A couple of nights ago, I woke up to a significant discomfort in my left knee; it's hard to explain, but it almost feels like my knee has a fever. The pain in my left knee has not only remained but has also begun to radiate towards my hip. Additionally, I've noticed that the skin surrounding my knee is extremely sensitive to touch and cold temperatures. There’s been no obvious injury, and I maintain an active lifestyle that includes hiking, running, and swimming, plus I'm at a healthy weight. Initially, I thought this might indicate gout, but that doesn’t seem likely given the circumstances. I would greatly appreciate any guidance or suggestions for seeking a diagnosis!
Answers (1)
8/13/2025, 8:31:37 PM
OpenHealth AI
It sounds like you’re dealing with significant discomfort in your right big toe and now pain in your left knee, which can be concerning. The symptoms you're describing could be related to several conditions, such as arthritis, tendinitis, or even a form of inflammatory response. Let's break this down and consider what you might do next.
Explanation
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Toe Pain: The sudden shooting pain followed by a dull ache in your right big toe could suggest gout, osteoarthritis, or another form of arthritis, especially since you’ve mentioned intense pain. However, the pain and sensitivities in your knee are noteworthy and may point toward a more systemic issue.
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Knee Pain: The discomfort in your knee that feels hot and sensitive to touch could indicate inflammation, possibly due to conditions like bursitis, tendinitis, or a form of arthritis (inflammatory or degenerative).
Next Steps
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Monitor Symptoms: Keep a diary of your symptoms, noting the intensity of pain, any swelling, changes in sensation (like warmth or sensitivity), and when these symptoms occur (e.g., after physical activities or at rest).
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Rest and Ice: Allow the affected joints (toe and knee) to rest. Ice the knee for 15-20 minutes every few hours to help reduce inflammation and relieve pain.
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Over-the-Counter Pain Relief: Consider using nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, if you can tolerate them. These can help manage pain and inflammation. Be sure to follow the recommended dosage on the package.
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Gentle Movement: Engage in low-impact activities to prevent stiffness, like stretching or gentle movements that do not exacerbate the pain. Avoid activities that put stress on your knee and toe.
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Evaluate Footwear: Make sure your footwear supports your activities properly. Shoes that provide adequate support can help reduce discomfort in your toe and knees.
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Consultation for Further Evaluation: Since both pain and swelling have developed in different joints, it may be beneficial to consult a specialist (like a rheumatologist) who can evaluate these symptoms comprehensively. They may recommend blood tests or imaging to pinpoint the exact cause of your symptoms.
If you notice significant swelling, persistent fever, or other severe symptoms, it’s important to seek medical attention promptly.
Please let me know if there's any other specific information you would like or if you have other concerns.
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Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.