Gout

Gout is caused by an elevation of uric acid within your blood.  Uric acid is a natural substance in your body that is a breakdown product of proteins.  Gout occurs in people who either make too much uric acid, eat too many foods that are high in uric acid, or in people who cannot get rid of excess uric acid in their blood.  Gout medicines focus on helping your body produce less uric acid, or helping your body eliminate excess uric acid.

Where does Uric Acid come from?

You naturally produce most of the uric acid in your body, but there is a percentage (up to 20%) of uric acid that comes into your body through diet.  Adjusting your diet by avoiding foods high in uric acid can help reduce your chances of repeat gout attacks.  In addition, keeping yourself very well hydrated with water is helpful.  Some medications can make a gout attack more likely, including some blood-pressure pills (water pills).  Your doctor may adjust these medications if gout becomes a problem.

In addition to medicine, you can help avoid future gout attacks by following the following diet guidelines:

Eliminate the following:

Liver    Kidney     Anchovies      Sweetbreads   Sardines      Brains     Heavy gravies      Heart    Fish roes    Mussels     Herring    Beer / Wine    Meat extracts, consommé

Reduce the following foods to no more than one serving per day:

Meats     Beans   Fowl     Peas   Cauliflower   Mushrooms Other seafood   Lentils     Spinach Yeast      Asparagus    Whole grain cereals    Fish (except noted above)

These foods do not cause gout:

Fruits     Milk       Cheese    Eggs     Refined cereals   Nuts   Spices (including salt)   Sugars & Sweets    Vegetable soups (clear)    Vegetables

Diagnosis & Treatment

A blood test may be used to test the uric acid level.  It is common; however, that the blood level of uric acid may be normal even while a person is having a gout attack.  If the diagnosis is in question, a sample of joint fluid may be taken and tested for gout crystals.  Most cases of gout affect the big toe joint but other areas can also be affected.  The pain can be quite severe and result in joint swelling and redness.  Walking may be difficult and pressure of a shoe or even bed covers can be painful.  Treatment for the acute, severe pain may include anti–inflammatory medications (such as indomethacin or colchicine) or injections near the area.  A sandal or surgical shoe may be useful to relieve pain as well.

Peripheral Neuropathy

Peripheral neuropathy

Peripheral neuropathy refers to disorders of the nerves which are outside of the central nervous system (nerves which are away from the brain and spinal cord).  Unfortunately, this problem is all too common.  Peripheral neuropathy can have various causes and produce many different symptoms.

Symptoms that involve the feet may include burning, tingling, numbness, or shooting pains.  Numbness often affects the bottom of the toes and balls of the feet.  Peripheral Neuropathy affects the longest nerves in the body first, which are the nerves that start from the bottom of the spinal cord and extend to the toes.  It is not uncommon for the big toe to be involved first.  If symptoms progress, the hands can become involved as well.  Some experience a sensation as if a band was around the foot or that a stocking was on when it is not.   At times the feet may be overly sensitive.  Even common sensations can be irritating such as the wearing of shoes, walking on carpet, etc.

Causes of Neuropathy

There are many causes of peripheral neuropathy.   It is quite common, however, that an exact cause cannot be discovered.  Poor circulation is usually not the cause of numbness.  So, numbness does not necessarily mean you are at risk as a result of poor blood flow!  Your health care provider will check your circulation to be sure it is adequate.

Known causes of peripheral neuropathy include:

¨ Diabetes (the most common cause)

¨ Alcohol toxicity

¨ Thyroid abnormalities.

¨  Nutritional deficiencies such as inadequate Vitamin B-12 or the  inability of the body to utilize vitamins and nutrients.

¨ Illnesses such as Guillian-Barre.

¨ Inherited conditions that affect nerves.

¨ Entrapment of nerves can occur with back problems, sciatica, or  tarsal tunnel (a pinched nerve near the inside of the ankle similar to carpal tunnel).

¨ Growths that press on nerves.

¨ Injury to nerves.

Drugs used in the treatment of cancer, HIV/AIDS, and other conditions

Treatment of Neuropathy

Treatment for peripheral neuropathy depends on the cause.  Blood tests or nerve conduction studies may be used to check for various causes.  If an underlying cause can be identified, such as diabetes, then treating that cause is important.  Injections or even surgery in some cases can relieve a pinched nerve.

Though symptoms may sometimes improve, the sensations such as numbness do not always go away.  If pain is associated with neuropathy, then your health care provider may recommend trying a cream such as capsaicin which is available without a prescription.   Your health care provider may also recommend the use of oral medications to treat neuropathic pain.  The types of medication often used to treat neuropathy are for other conditions such as seizures or depression.  Common medications that may be prescribed are Neurontin, Lyrica, or Cymbalta to name a few.  Many individuals find that neuropathy is most irritating or painful when trying to go to sleep as there are no distractions from the irritation.  Occasionally, neuropathy medications are combined with pain medications, such as Ultram, to help patients through the initial period as the Neuropathy medications may take some time to reach their maximum benefit.  The important point to remember is there is treatment available, which is tailored to fit each individual patient.  Check out our website www.alaskapodiatry.com.  Also see us on twitter (alaskapodiatry), and become a fan on facebook (Alliance Foot and Ankle).

Hallux Rigidus/Limitus

Hallux Limitus/ Rigidus

Hallux Limitus/ Rigidus is a condition where the big toe joint degenerates and becomes stiff and arthritic.  The hallux (big toe) needs to flex upward and downward at the first metatarsal phalangeal joint (big toe joint) to function normal.  Due to certain conditions such as trauma/ injury, genetic predisposition to faulty structure, generalized (whole body) arthritic conditions or prior surgery, the big toe joint may start a process known as degenerative joint disease.  This progressive condition leads to wearing out of the articular cartilage (the pearl white shinny tissue seen where two bones form a joint), and the big toe joint starts to become stiff and painful to move.  Once the body recognizes that this process is occurring extra bone is laid down around the joint (bone spur) to begin a process of fusing the joint solid thus no motion, no pain.  While this process is occurring pieces of the extra bone can break off into smaller fragments and cause pain to the joint.

            Hallux limitus is more common in men than women but plenty of active women are diagnosed with the condition.  It consists of four stages.  Most people are unaware of any symptoms in stage one other than possible progressive joint stiffness.  Many present for treatment in stage two as the joint becomes more painful to move and fracture fragments may start to jam the joint.  If left untreated as one progresses toward stage four the joint becomes very stiff and bulbous as the body places bone around the joint in an attempt to fuse it (no motion, no pain).  Small amounts of motion though stiff occurs and the poor quality of this motion combined with extensive bone spur development (some pieces may even be fractured) can lead to extreme pain with ambulation.

            Treatment is patient specific depending on age, activity level, type of employment, stage of condition, prior treatment, shoe choices, and expectations.  Hallux limitus is progressive over time and is not reversible.  Non-surgical treatments may alleviate pain and slow progression.  Stiff sole shoes with an appropriate orthotic (shoe inlay) may off load the great toe joint and support the transverse and longitudinal arch of the foot.  Anti-inflammatory medications and injections into the joint can temporarily ease symptoms.  Self-directed or formal physical therapy may help improve function, decrease swelling, and increase local blood flow.  As the condition progresses with increased pain and decreased function, surgical options are usually considered.  If it is possible, an attempt is made to reconstruct the degenerative joint to reduce the stage of the condition.  This preserves ones natural joint and although far from perfect may function pain free for many more years.  As one advances to stage three or four, reconstructing ones joint may not be possible and joint destructive procedures such as a joint implants or surgical fusion need to be considered.  Joint implants may be limited to a select type of person.  Joint fusion (arthrodesis) is a very powerful procedure to eliminate pain and still allow for a high level of activity.  Joint fusion requires a committed rehabilitation and understanding that adjacent joints can be affected in the future.