Tuesday, May 17, 2022

Big Toe Pain Gout Or Arthritis

Gout Arthropathy Or Podagra

Big Toe Pain – Everything You Need To Know – Dr. Nabil Ebraheim

Another common cause of big toe arthritis is gout arthropathy. Gout is characterized by the excessive production and deposition of uric acid crystals into the joints. One of the most common sites of gouty arthritis is the great toe. This condition is also known as podagra.

An episode of gouty arthritis will present very acutely, or suddenly, with severe pain, redness, swelling, and warmth around the joint.

With each attack, the joint cartilage is damaged, predisposing patients to irreversible arthritis in the long run. This is why patients with gout require treatment to avoid the number of recurrent episodes over their lifetime.

Maintain A Healthy Weight

Your entire body weight falls on your feet while standing, which puts a lot of strain on your toe joints. The heavier you are, the more stress your joints will have to endure.

Under such conditions, even simple but regular activities such as walking can cause wear and tear in your joints, which can worsen over time. Maintaining a healthy weight is therefore very important to minimize joint degeneration.

The best way to stay fit and reach your weight goals involves a 2-part approach:

  • Eating a nutritious, well-balanced diet
  • Burning the extra calories through some form of physical activity done for about 30 minutes daily

Gout Vs Turf Toe: How To Tell The Difference

Toe and foot pain are no joke they can be very uncomfortable and affect your everyday activities. Gout and turf toe are two conditions that can cause pain and swelling of your big toe and its joints, reducing mobility. Although some of the symptoms may initially show up in the same ways, the underlying causes and treatments are different.

Knowing more about these conditions can help you know the difference between them and lead you to get the best treatment for your pain.

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How Uric Acid Crystals Form

Infographic

The build-up of uric acid crystals begins with purines, a chemical compound found in many foods.

  • When the body metabolizes purines, it produces a substance called uric acid.
  • The uric acid enters the bloodstream.
  • The kidneys filter the blood and normally filter out excess uric acid. This uric acid is then excreted via urine or stool .10
  • If the kidneys cannot adequately filter out excess uric acid, or if the body produces too much uric acid, there will be too much uric acid in the bloodstream.
  • Too much uric acid in the bloodstream is called hyperuricemia.
  • In some people, hyperuricemia leads to the formation of uric acid crystals that collect in joint tissue, leading to painful symptoms.

An inability to adequately process and excrete uric acid accounts for an estimated 90% of gout cases.9 Other cases occur because a body produces too much uric acid.

Can A Bunion And Big Toe Arthritis Occur Together

Gout in big toe: How to identify, causes, and treatment

Sadly, yes they can. And when a bunion and big toe arthritis occur together it is a more complex foot deformity.

Sometimes arthritis accompanies a bunion due to the abnormal position of the joint. Usually, the bunion deformity has progressed by repetitive trauma or a distinctive injury. Thus begins arthritis.

There can also be a bunion component to big toe arthritis because the bone can move a bit over. This is often corrected at the time of the joint clean-up.

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What Are Some Of The Main Early Symptoms Of Big Toe Arthritis

There are three main early symptoms of hallux rigidus: stiffness, pain and swelling.

A loss of toe motion upwards is also another symptom most commonly noted early on. At a later stage, loss of motion downwards , locking and catching of the joint can occur.

In early arthritis, the pain is generally felt more over the top of the joint particularly with dorsiflexion of the joint. This is due to impingement.

Physical Therapy For Arthritis In Toes

Your doctor may send you for physical therapy to help improve your range of motion and strengthen the muscles around your foot. Physical therapy can increase pain-free range of motion and strengthen the muscles of the foot to take pressure off the painful joint, says David Geier, MD, an orthopedic surgeon, sports medicine specialist, and author of Thats Gotta Hurt: The Injuries That Changed Sports Forever. These exercises relieve stiffness and increase your ability to move your joints through their full range of motion.

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Joints Affected By Gout

Gout can affect any joint, but some joints are more likely to be affected than others. Joints commonly affected include the big toe, the foots instep, heel, ankle, and knee.2 Less often, gout affects the elbow, wrist, fingertips, or spine.27

Gout is acute, painful swelling in the joints from uric acid buildup. Common areas include the foot and big toe.

Who Should Diagnose And Treat Gout

Natural gout treatment big toe pain at home

The disease should be diagnosed and treated by a doctor or a team of doctors who specialize in care of gout patients. This is important because the signs and symptoms of gout are not specific and can look like signs and symptoms of other inflammatory diseases. Doctors who specialize in gout and other forms of arthritis are called rheumatologists. To find a provider near you, visit the database of rheumatologistsexternal icon on the American College of Rheumatology website. Once a rheumatologist has diagnosed and effectively treated your gout, a primary care provider can usually track your condition and help you manage your gout.

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Stubbed Or Broken Toes

You probably dont need us to tell you what a stubbed toe is. Almost everybody has at least one or two vivid memories of a time when they smashed a toe into a wall, table leg, bed frame, threshold, raised curbyou get the idea.

Stubbed toes are almost always painful, accompanied by throbbing pain, localized swelling, and temporary difficulty with walking or wearing shoes. The good news is that most cases are relatively minor and can be alleviated by following RICE therapy .

That being said, stubs can also cause more severe problems that might need more direct treatment from our office, especially if there are any broken or dislocated bones. Call us immediately if you notice any of the following after your toe injury:

  • Severe pain and/or bruising
  • You cant move the toe, or moving it causes increased pain
  • The toe appears deformed or out of place
  • Numbness or cold sensations
  • Unusually pale skin

Effective Medical Treatment For Gout

The American College of Rheumatology released gout management guidelines in 2012 and updated them in 2020. They recommend drugs classified as urate-lowering therapy for those who have experienced two or more gout attacks in a year as well as for those with joint damage from gout.

Specifically, the organization recommends allopurinol as a first-line treatment for all gout patients, even those with chronic kidney disease. Next in line is febuxostat both are a class of drugs called xanthine oxidase inhibitors.

In addition, the guidelines recommend use of anti-inflammatory medications including NSAIDs, prednisone, or colchicine along with the other medication.

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What Can I Do About My Big Toe Pain

As with any painful problem you might be experiencing with your feet and ankles, a visit to Dr. Timson at the Community Foot Clinic of McPherson should be high on your to-do list. We are experts at keeping the people of McPherson, Saline, Reno, Harvey, and nearby counties on their feet!

When it comes to big toe pain, many different conditions can produce very similar symptoms. However, the optimal treatment approach may be radically different depending on the precise nature of your injury or condition, as well as your personal activity goals.

The way we might manage an early-stage bunion, for example, may be quite different from what wed recommend for turf toe or gout. Bunions, as a progressive deformity, require ongoing preventative management. Turf toe is a soft tissue injury that just needs the right time and care to heal, while gout often requires dietary modifications and medications.

In short, the earlier you stop by to get a thorough examination, accurate diagnosis, and personalized treatment plan, the better off youre going to be in both the short and long runs. That means less pain, more activity, and fewer trips to the foot doctor.

To request an appointment with Dr. Timson, complete our online contact form or give our office a call at .

What Are The Symptoms Of Oa In The Toe

Gout

Even in the early stages, arthritis in the toe can cause tenderness, achiness, and joint pain. You may also feel achiness or pain in other toes or the arch of your foot as you walk.

Over time, you may even develop a burning sensation, which is a hallmark sign of nerve pain, or neuropathy.

An arthritic toe may ache after long periods of sitting or when you first wake up in the morning. Stiffness and pain is typically a sign of OA after long periods of inactivity or immobility.

Overgrowth of the big toe bone can make it difficult or even impossible to bend your toe.

More specifically, in people with OA, the joint degenerates and a reactive bone process is triggered, such as spurs or ankylosing. The excess bone growth can lead to fusion of the joint and a fixed, or non-bending joint. The result is a stiff toe, which is also called hallux rigidus.

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How Can An Attack Of Gout Be Treated

The management of an acute attack of gout is very different from the prevention of subsequent attacks.

Treatments used for prevention, such as allopurinol can actually make things worse if given during an attack, and so need to be held back until the attack has resolved for several weeks.

There are a number of measures that can help resolve an attack of gout. See Table 2 for summary of treatment strategies for acute gout. One principle is that treatment for an attack of gout should be instituted quickly, since quick treatment can often be rewarded with a quick improvement.

If an attack of gout is allowed to last more than a day or so before treatment is started, the response to treatment may be much slower.

Table 2: Medications to treat acute attacks of gout

  • Nonsteroidal anti-inflammatory drugs or COX-2 inhibitorsExamples of : Naproxen 500mg twice daily, indomethacin 25mg three times daily. Example of COX-2 inhibitor: celecoxib 200mg twice a day. Possible side-effects: Elevation of blood pressure, ankle swelling, upset stomach, ulcer . Use with caution if kidney or liver problems.
  • Anti-Inflammatory corticosteroidsExamples of : Prednisone 40mg first day, 30mg 2nd day, 20mg third day, 10mg fourth day. Possible side-effects: Elevation of blood pressure, elevation of blood sugar, mood changes. Short-term use, as in gout, generally much better tolerated than long-term use. Use with caution if diabetic.
  • What Else Should I Ask My Healthcare Provider About Gout

    Consider asking your healthcare provider:

    • What is causing the gout?
    • Do I have any joint damage?
    • What can I do to prevent future attacks?
    • Can any gout medications help me?
    • How long will I need to take gout medications?

    A note from Cleveland Clinic

    Gout is a painful form of arthritis. Extra uric acid in your body creates sharp crystals in the joints, leading to swelling and extreme tenderness. Gout usually starts in the big toe but can affect other joints. Gout is a treatable condition, and the uric acid level can be decreased by medication and lifestyle changes. Talk to your healthcare provider about medications that can reduce uric acid levels. They can also discuss changes you can make to your diet and lifestyle to prevent and reduce gout attacks.

    Last reviewed by a Cleveland Clinic medical professional on 11/15/2020.

    References

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    Why Does My Big Toe Hurt Suddenly

    When we think of gout, we might think of Renaissance-era royalty and indulgent feasts. But gout is still very much with us in the 21st Century. Gout is actually a type of arthritis that can affect any joint in the body. But it often strikes first in the form of sudden pain in your big toe. Heres a look at what causes gout, how to treat and prevent it, and why our big toe is so susceptible.

    Which Joints Are Involved In Gouty Arthritis And Why Is It Most Common In The Foot

    Big Toe Joint Pain Relief – Step 1

    As with all other known types of arthritis, Gout has particular joints it tends to attack, and the foot is its most common location. Gout especially favors the bunion joint, known as the first metatarsophalangeal joint , but the ankle, midfoot and knee are also common locations, as is the bursa that overlies the elbow.

    The bunion joint is the first joint involved in 75% of patients and is ultimately involved in over 90% of those with this condition. . It is thought that this joint is especially involved in gout because it is the joint that receives the highest pounds per square inch of pressure when walking or running.

    Late in gout, if untreated, multiple joints can be involved, including the fingers and wrists. The shoulder joint is very rarely involved by gout and the same is true of the hip.

    Figure 5: Location of Gout Attacks

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    Reduce The Pressure Reduce The Pain

    Gout cant be cured, but it can be managed effectively and ensuring that your feet receive expert care plays an important part in that process.

    Our London podiatrists can help to relieve the pain caused by gout in your big toe with prescription orthotics. These custom-made shoe inserts are designed to make the affected area more comfortable by reducing the pressure its under. Whats more, we can offer expert advice on which shoes youll find most comfortable.

    Podiatric padding and foot shields can be beneficial when gout strikes. In addition, if the swelling has led to sores, ulcers, calluses, etc., we can treat those issues too.

    For expert help to relieve the foot pain caused by gout, please call Feet By Pody today on 0207 099 6657 or book a podiatry appointment online.

    Gout Doesnt Have To Be A Pain

    Gout attacks can be recurring. Over time, the condition can harm your joints, tendons, and other tissues if not treated correctly. The best course of action with the fewest side effects is to follow a gout-friendly diet and limit your intake of red meats, seafood, and alcohol. If you suffer from gout and want to try a holistic approach to treating the disease, be sure to check with your doctor to make sure this is the right course of action for you.

    Ellis, R., Fighting the agony of gout with a daily glass of cherry juice, Daily Mail, September 28, 2014 .Treatments and Remedies for Gout, Mercola , last accessed May 5, 2017.Gout: Facts and Information, Mercola , last accessed May 5, 2017.

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    Whats The Outlook For People With Gout

    Untreated gout can lead to permanent joint damage. The buildup of uric acid in the joints and soft tissue is called tophus. Some people with gout can also develop other health problems, such as severe arthritis, kidney stones and heart disease. Its important to discuss your symptoms with a healthcare provider.

    How Can A Gout Attack Be Prevented

    Help! Is That Pain in My Toe Gout?: Rheumatology Center of ...

    Diet plays a key role diet in gout prevention: Since foods can directly set off gout attacks, patients with gout should receive counseling as to which foods are more likely to induce attacks. Losing weight is often also helpful. However, as important as diet is in gout, for most people with gout diet, and even weight loss, are not enough, and medications will be needed to get to their uric acid goal.

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    Manage Your Gout Effectively

    If gout is present, preventing the number of attacks is key to preventing or delaying the formation of big toe arthritis. This is obtained by dietary management and limiting your intake of purine-rich foods.

    Proper medical management of your gout, which may include daily medications such as allopurinol or episodic medications such as colchicine or steroids, will also help limit the amount of joint destruction.

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    What Are My Treatment Options

    It is generally wise to trial non-surgical treatments prior to considering surgery. In some cases of mild arthritis, an injection into the joint may provide meaningful pain relief but it may not be long-lasting and it is not permanent.

    For those with ongoing symptoms that are affecting quality of life, then surgery is often an attractive option. Motion and joint-preserving procedures are preferred wherever possible but it is worth noting that even joint fusion surgery has good results when indicated.

    The main surgical procedures available to patients suffering from big toe arthritis include the following:

    • Cheilectomy: this small procedure simply removes the bone spurs. It preserves joint motion and can be very successful, particularly for early arthritis.
    • Osteotomy: this involves realigning the joint. It is only indicated in certain circumstances, but preserves joint motion and can be helpful in mild to moderate cases.
    • Joint replacement: much like the hip or knee, the big toe joint can be replaced. It is reserved for more advanced cases of arthritis. Not all arthritic toe joints will benefit from this treatment.
    • Fusion: if the joint is very badly damaged, then fusing it shut is a good choice, as this operation has a very high success rate. Although it sounds alarming, the loss of motion of the main toe joint is well accommodated by the other joints of the foot and the pain relief is excellent.

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