### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
My big toe feels just like Ive gotten stuck with a large needle.  It keeps happening out of the blue over and over.  I read online some folks talking about fibromyalgia, but I have never been diagnosed with it or had any of the other symptoms. Very healthy otherwise!  This just keeps happening.

### output:

Hello, and thank you for your question. Fortunately, you probably do not have fibromyalgia.  There are several possible causes of pain just in the toe.  If there is a pinched nerve in the lower spine, it can cause pain that can be just in one toe.  If this is the case, you may find that the pain is worse with change in position, such as lying flat or standing up. Pain in the toe, typically the big toe, is common in a disorder called gout, in which the body has too much uric acid.  The pain usually lasts a few days at a time, and is usually associated with redness and swelling. Pain in the toes can be caused by corns or other skin problems that look small but feel very severe. Pins and needles, shooting, on-and-off pains can be caused by irritation to a nerve by diabetes, by lack of vitamins such as B12, or by pressure - similar to the "foot falling asleep" feeling we sometimes get if we cross our legs too long. Fibromyalgia, on the other hand, is usually a "pain all over" problem - back pain, neck pain, arm pain, knee pain, without another cause such as arthritis.  It usually does not cause just one part of the body to hurt - most patients say that "everything hurts". In my practice, I start with finding out as much as I can from the patient about how the pain feels and how long it has been going on, and if it seems related to anything else.  Then we examine the foot to look for anything going on with the skin, check if the nerves of the foot are normally sensitive, not as sensitive as usual, or more sensitive, and then we may check blood tests to detect diabetes or vitamin deficiency or other problems as needed. Fibromyalgia is diagnosed by obtaining a careful history of where the patient is having pain, other medical problems, and completing a physical exam including what is called a "painful point" exam where the doctor pushes at certain places in the body - on the back and near the joints - to see if this causes pain. I hope that my answer to your question is helpful.  If you have any further questions, please check back with us.  I hope your toe is much better soon.