The Silly Season

Towards the end of August, I found myself on a short hike out in Ham Tin. The day finished with seafood and wine in Sai Kung town. The following day, I woke up with a very achy sore right foot second toe; at the time I attributed the soreness to walking 45 minutes (yes, it was a short hike) in thongs. The soreness lasted a couple of months. Fast forward to Christmas Day and once again I've woken up with an incredibly sore foot. Specifically, where the big toe meets the ball the right foot. Different toe, same achy pain. Curious situation. I didn't kick a cinder block, or walk any substantial distance, I wasn't wearing new shows. Two separate instances that I've woken up with a sore toe, with no obvious moment of trauma.

So me, being me, I do three things. The first thing. I try to identify shared commonalities with the lead up to both events. One day of walking, one day without much walking. One day with lots of wine, one day with lots of wine. One day of outdoor activities, one day of socialising. One day with lots of cheese and seafood, one day with lots of seafood and purine-rich foods (think: liver and red meat). The second thing. With the help of the internet I jump to conclusions. The third thing. I go to my doctor and tell him that I think I have gout. He seems skeptical about this non-medical diagnosis based purely on my symptoms and my previously low uric acid levels appeared to suggest that gout did not seem likely. He then refers me to a foot specialist.

The Orthopaedic surgeon - she also doesn't think it's gout. Overarching medical consensus is that I would not be able to walk and that I would be experiencing more pain, even with acute gout. One thing that I've realised with my year of interaction with the medical system is that it's a lot of trail and error, attempting to diagnosis the symptoms with the aide of scans and test to come to a conclusion. We take an X-ray and find that there's no fracture, however there is a bit of bone that is floating right above the big toe. Which although unusual is unlikely to be the cause of my sore right toe. 

Here's the report:

The patient complained of right big toe pain and second toe pain for a few days. There was no history of injury. There was no family history of gout. The pain was exacerbated on walking. There was no rest pain. He also complained of left ankle instability symptoms. There was history of recurrent sprain for years. He last sprained his left ankle in mid Nov 2020.

On physical examination, there was minimal hallux valgus and bunionette deformity. There was no claw toe. There was mild callosity over the right second metatarsal head. There was a 5mm mobile roundish bony swelling at the right foot dorsum at subcutaneous plane. It was non tender on palpation and the Tinel sign was negative. 

For the left ankle, there was tenderness along the anteromedial joint line; there was also tenderness over the anterior talo-fibular ligament (ATFL) and the calcaneo-fibular ligament (CFL). The posterior talo-fibular ligament was non tender. Lateral laxity was grade 2.

X-ray right foot showed a bony loose body around the first metatarso-phalangeal joint, and minimal hallux valgus deformity.

So the soreness is likely to be caused by mild Hallux Valgus, or poor foot stability. However, in the space of 24 hours, I've gone from thinking that I have a uric acid problem, to finding I have a free floating piece of bone in my right foot, to having to get an MRI on my left ankle. It really is the silly season.