What is the most likely cause of severe pain in the great toe without trauma?

• A. Plantar fasciitis
• B. Gout
• C. Osteoarthritis
• D. Arthritis

Answer: (B)

The main idea is recognizing a crystal-induced inflammatory arthritis when a person has sudden, severe pain in the big toe without any obvious injury. Gout fits this pattern best because it commonly involves the first metatarsophalangeal joint and causes an abrupt, intensely painful, red, swollen, and warm big toe attack that can wake someone at night. The underlying problem is monosodium urate crystals forming in the joint due to high uric acid levels, which triggers a strong inflammatory response.

Plantar fasciitis would show heel pain, especially with the first steps after resting, not isolated to the big toe. Osteoarthritis of the great toe tends to produce a more gradual, persistent ache with stiffness and possible joint enlargement over time, rather than an abrupt, severe attack. The broad term arthritis is nonspecific and wouldn’t explain the sudden, toe-specific presentation as clearly as gout does.