What Is Turf Toe
Turf toe, or hyperextension, is when you bend your big toe too far toward the top of your foot. It can cause a sprain of your toe or your ligaments surrounding it. Turf toe is a kind of metatarsophalangeal joint sprain, which means that at least one of your joints connecting your toe to the rest of your foot is injured.
Turf toe can happen during any sport or activity when your forefoot is on the ground with your heel up, and then you are pushed into a position of hyperextension of your toe. It most often occurs among football players on artificial grass. This is because the turf is harder and not as shock absorbent. Turf shoes also often have less protection in the forefoot because they tend to be more flexible.
Treatment for turf toe depends on the severity of the injury, which ranges from grade 1 to 3:
- Grade 1. Treatment for grade 1 turf toe involves the RICE method, which can be done at home, along with taking nonsteroidal anti-inflammatory drugs . You can return to sports once you can tolerate this level of activity.
- Grade 2. Grade 2 treatment focuses on improving your symptoms, which may include wearing a walking boot and partial weight-bearing. An MRI may be done to get a better idea of the extent of your injury.
- Grade 3. Grade 3 injuries may require 8 or more weeks of recovery and immobilization, and sometimes even surgery.
- joint pain or stiffness
- being unable to move your toe typically
- redness, discoloration, or swelling around your toe and joint
Symptoms Of Ankle Gout
Doctors can sometimes misdiagnose gout in the ankles as a variety of other illnesses like a sprained ankle or cellulitis. But there are a few symptoms that Frisco patients can look for that could indicate its actually gout.
Pain While a sprained ankle may be tender, gout is usually extremely painful. Many patients find it difficult to even walk during a gout attack.
Stiffness Many patients report that their ankle joint will become stiff when a gout attack is setting in. It may start with a dull ache that turns into severe stiffness.
Color Joint affected by gout will almost always be very red, often a very bright red.
Swelling Of course, another symptom of gout is intense swelling at the joint.
Texture Another telltale sign of gout is that the skin will be shiny.
Temperature With gout, the ankle joint will be very warm to the touch.
What Increases Your Chances For Gout
The following make it more likely that you will develop hyperuricemia, which causes gout:
- Being male
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What Does Gout Look Like On Your Foot
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Treating A Gout Attack
Treating an attack of gout doesnt lower your urate levels or stop future attacks. The treatment helps you to manage your symptoms when an attack happens.
The most commonly used drug treatments for attacks of gout are:
Some people will be better suited to NSAIDS, while others will be suited to colchicine. But your preference is also taken into consideration many people with gout quickly learn what works best for them.
In cases where one drug doesnt seem to be working on its own, your doctor might suggest a combination of NSAIDs with either colchicine or steroids.
Non-steroidal anti-inflammatory drugs
Attacks of gout are often treated with NSAID tablets, which can help with pain and reduce some of your inflammation. Ibuprofen, Naproxen and diclofenac are three NSAIDs you could be given.
If youve been prescribed NSAIDs to treat an attack, you should start taking them as soon as you notice signs of one coming on. Your doctor may let you keep a supply so you can start taking them at the first signs of an attack.
The earlier you start treatment, the better.
NSAIDs arent suitable for everyone, so talk to your doctor about them first if you have any other conditions. They can also interact with other drugs, so make sure you talk to a doctor before starting on any new medication.
Colchicine isnt a painkiller, but can be very effective at reducing the inflammation caused by urate crystals.
Colchicine tablets can cause diarrhoea or stomach aches.
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Is Knee Pain Due To Gout Or Something Else
Most people with gout in the knee experience intense pain during a gout attack. Swelling may also be noticeable during an active flare, as well as redness and warmth.
The pain may develop in the night and hurt continuously for up to two weeks before the flare subsides, with the most intense pain in the first 24 hours. But if gout is not treated, typically with medication to lower uric acid levels, gout flares will recur and over time and affect more joints, including the knee.
Doctors cant say for sure why gout flares occur more often at night but, according to a 2015 study, it might be because your body temperature goes down at night, which could make uric acid more likely to crystallize.
Although the pain of a gout attack is distinct, there may be other reasons for your knee pain you should be aware of.
Your knee pain could be caused by buildup of different kinds of crystals called calcium pyrophosphate . Doctors can examine fluid in your inflamed knee to determine if the crystals are uric acid or calcium pyrophosphate.
How Are Gout And Turf Toe Different
In gout, the damage to your joint is from internal mechanisms, meaning the uric acid buildup and urate crystals. With turf toe, the injury to your joint is from an outside force that bent the foot in a certain way.
The symptoms of gout are due to the uric acid crystals forming on your joints or around your soft tissue, making it hard to move joints and causing pain. In turf toe, the symptoms are from the hyperextension of your toe and surrounding joints and ligaments.
Gout can be managed with diet, medications, and lifestyle changes. None of these treatment strategies overlap with those for turf toe. Treatment for turf toe depends on the injury and accompanying symptoms medication is solely used to relieve the pain.
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Common Myths About Gout
Drinking too much alcohol and eating too much rich food were once considered the prime suspects in causing gout. Although eating certain foods and drinking alcohol may cause uric acid levels to spike, these habits alone may not cause gout.
A recent study indicates that our DNA is a key factor in gout flare-ups. Researchers found that diet was less important than genetics in determining whether or not patients would develop high levels of uric acid.
If you suspect you have gout, make an appointment with your doctor to be tested and learn how to prevent or reduce future gout attacks.
Treatment Of Foot Gout
If you suffer from foot gout, there are many different types of gout treatment approaches you can take to help lessen the flare.
Flares from foot gout can be treated using your regular gout medications. This includes NSAIDs, corticosteroids, and colchicine. These are short-term gout medications and should only be taken during a gout flare.
Then, certain medications need to be taken regularly to maintain low uric acid levels. This is called preventative medication and can include drugs such as allopurinol, febuxostat, probenecid, pegloticase, and lesinurad.
Light Exercise or Rest
This may sound counterintuitive but taking a walk during an attack might help you recover faster. For people who have had gout long enough, theyve lived through the pain and have gotten used to it.
However, if this doesnt work for you dont force it. Sit back, relax, and let your foot rest. Put it in an elevated position and place an ice pack on the affected area.
Buy a Comfortable Pair of Shoes
Find comfortable shoes that you can regularly wear preferably those that have cushioned insoles and a wide toe box. This helps support the feet and prevent contact with the toe which can feel sensitive to touch during the first few days after an attack.
In certain situations, you may need to undergo an operation to remove the liquid inside. This is especially needed if the gout has already progressed into tophi.
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Medications For Acute Gout
Uric Acid Is The Cause
When there is an overabundance of uric acid in the blood it is called gout. Usually, having too much uric acid in the blood is not harmful. In fact many people with high levels in their blood never know about it. When uric acid levels in the blood become extremely high, the uric acid may start to form crystals. These crystals most commonly form in the joints, especially the joints in the big toe. Your odds of experiencing the pain of gout are higher if you are overweight, drink excessive amounts of alcohol, or have a diet that is comprised of meat and fish that are high in chemicals called purines.
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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.
How To Treat Gout In Foot At Home: You Have To Know This
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How Are Gout Attacks Prevented
Maintaining adequate fluid intake helps prevent acute gout attacks and decreases the risk of kidney stone formation in people with gout. Alcohol is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism and cause hyperuricemia. It causes gout by slowing down the excretion of uric acid from the kidneys as well as by causing dehydration, which precipitates the crystals in the joints.
Differences Between Men And Women
Sex differences play a role in which joints are affected:
- In men, about 85% of gout flare-ups affect joints in the lower extremities. About 50% of first-time gout attacks involve a big toe joint.8
- In women, a gout attack is most likely to occur in a knee.10 In addition, women may be more likely to get gout in the upper extremities.9
While women are less likely to get gout, they are more likely to have multiple joints affected by gout.13
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Managing A Gout Flare
Gout flares are unexpected and painful heres how to get a handle on them.
Few things in life are more painful than a gout flare, so if youre awakened in the wee hours by a joint that is tender, swollen, red and radiating heat, youll want to act fast. Heres what you can do when a gout flare starts to ease the pain of and reduce the risk of others.
How Is Gout Diagnosed
In a clear-cut case, a primary care physician can make the diagnosis of gout with a high level of confidence. However, often there are two or more possible causes for an inflamed toe or other joint, which mimics some of the symptoms of gout, so tests to identify the presence of uric acid is performed.
Since the treatment for gout is lifelong, its very important to make a definitive diagnosis. Ideally, the diagnosis is made by identifying uric acid crystals in joint fluid or in a mass of uric acid . These can be seen by putting a drop of fluid on a slide and examining it using a polarizing microscope, which takes advantage of the way uric acid crystals bend light. A non-rheumatologist, when possible, can remove fluid from the joint by aspirating it with a small needle and send it to a lab for analysis. A rheumatologist is likely to have a polarizing attachment on their microscope at their office. Gout crystals have a needle-like shape, and are either yellow or blue, depending on how they are arranged on the slide .
Figure 11: Uric Acid Crystals Under Polarizing Light Microscopy
There are many circumstances where, however ideal it would be, no fluid or other specimen is available to examine, but a diagnosis of gout needs to be made. A set of criteria has been established to help make the diagnosis of gout in this setting .2
Table 1: Diagnosing gout when no crystal identification is possible
Ideally, 6 of 10 features will be present of the following:
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Caring For The Foot At Home