What condition involves severe pain in the great toe without trauma?

• A. Tendonitis
• B. Fracture
• C. Bursitis
• D. Gout

Answer: (D)

Severe, sudden pain in the big toe with no preceding injury points to gout. This condition is caused by monosodium urate crystals that deposit in the first metatarsophalangeal joint (podagra), leading to abrupt, intense pain along with redness, warmth, and swelling. The absence of a trauma history helps distinguish it from a fracture, while tendonitis would involve pain along a tendon from overuse, and bursitis would cause swelling over a bursa rather than a classic single swollen toe joint. Diagnosis is supported by high uric acid levels and, if examined, needle-shaped crystals that are negatively birefringent in the joint fluid. Treatment targets rapid relief of the acute attack and long-term urate lowering to prevent recurrences.