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I suffered a big toe fracture in right foot 4 months back, which triggered a gout attack within couple of days of the injury. Since then, I have got it treated for Gout and Fracture both. The fracture has healed and I am on Allopurinol for last 7 weeks. My problem is that my right foot is not getting free and the soreness is not going away. I am not sure if it is due to gout or the fracture. Hence, I am requesting thoughts, opinions and experience of other members to help me in this. My current pain symptoms are –
1. When I wear the shoes, I feel extra padding under the big toe ball of right foot, though visibly there is no swelling
2. The movement of right big toe is 70% of left toe. I do not know if it was like that even before the injury /gout attack
3. When I walk, at times I feel pain in the right toe, more so when it gets bent a bit more
4. My load on the righ foot is not balanced and when I walk, some of the body weight gets shifted towards middle to small toe. This makes me try to push my body weight on right toe and causes pain in the right toe
5. The joint ( Bursa) feels weak and tender in right foot. When I walk barefoot, I can feel the weakness and extra pressure.
6. When I walk with shoes, I sometimes feel the whole right thumb painful for couple of seconds. The pain goes away as soon as I remove my shoes and wear them again.
7. After I sit for some time like 30 minutes or so and stand up, the balls under the right toe are slightly painful and sore. The pain goes away after I have walked for about 10-20 steps.
8. I do get twinges in the right big toe and nearby area every day when I am walking and the foot feels more tired and achy.
I am not sure if some or all of the above symptoms are gout-related. Any experience on the residual gout pain symptoms would be helpful to clear doubts in my mind.
Thanks.
Why is your Gout Pain still Lingering? One clarification on the point 3
3. When I walk, at times I feel pain in the right toe, more so when it gets bent a bit more
The pain is more on the bottom side of the right toe at the point where the right thumb ends..
Have you considered Tendonitis, or maybe Fibrositis? This can take a long time to clear, Aspirin was best for my episodes, many years ago.[Worsened by heat and high humidity].
This could be gout related too- and a lot has happened to you in one episode already.
It will take time to heal- I have low level remnants of old attack pains capable of arising anytime over many weeks, if joints are contiually stressed.
[ I walked 20 miles total- last week, in two walks]
You're on the right treatment and doing well.
The movement restriction, you quote remaining, seems too much to ignore.
I would re-present to your medical support.
Utubelite said:
I suffered a big toe fracture in right foot 4 months back, which triggered a gout attack within couple of days of the injury. Since then, I have got it treated for Gout and Fracture both. The fracture has healed and I am on Allopurinol for last 7 weeks. My problem is that my right foot is not getting free and the soreness is not going away. I am not sure if it is due to gout or the fracture. Hence, I am requesting thoughts, opinions and experience of other members to help me in this. My current pain symptoms are –
1. When I wear the shoes, I feel extra padding under the big toe ball of right foot, though visibly there is no swelling
Yup. Had that for about 2-3 weeks. It feels very odd!
2. The movement of right big toe is 70% of left toe. I do not know if it was like that even before the injury /gout attack
Not sure in your case, but I had that at one point.
3. When I walk, at times I feel pain in the right toe, more so when it gets bent a bit more
Yup!
4. My load on the righ foot is not balanced and when I walk, some of the body weight gets shifted towards middle to small toe. This makes me try to push my body weight on right toe and causes pain in the right toe
Yup!
5. The joint ( Bursa) feels weak and tender in right foot. When I walk barefoot, I can feel the weakness and extra pressure.
Yup!
6. When I walk with shoes, I sometimes feel the whole right thumb painful for couple of seconds. The pain goes away as soon as I remove my shoes and wear them again.
Yup!
7. After I sit for some time like 30 minutes or so and stand up, the balls under the right toe are slightly painful and sore. The pain goes away after I have walked for about 10-20 steps.
Yup. Probably due to circulation issues having an impact on your gout
8. I do get twinges in the right big toe and nearby area everyday when I am walking and the foot feels more tired and achy.
The more I walked the worse I felt!
I am not sure if some or all of the above symptoms are gout related. Any experience on the residual gout pain symptoms would be helpful to clear doubts in my mind.
Thanks.
Utubelite,
As you see I too had most of your symptoms. That is not to say that yours are from gout only and not the fracture, however I'm leaning on the gout. To be perfectly honest with you, I had pain for a straight 2 months. I found that it would start to go away, however as soon as I went back to the gym or the park to resume exercising (walking) the next day I was damn near back to square one. Finally I gave in to staying off it and taking colchicine. My advice (just my opinion), would be to do a 12-16 colchicine cycle for a day. If that doesn't take care of the issue then the pain is probably fracture related.
I agree with cjeezy. Most of your symptoms sound very gout-like, but we cannot rule out damage related to the toe fracture. The foot is extremely complex, and damage to another bone cannot be ruled out. The reality is, that getting a perfect diagnosis is almost impossible, and if scans do not reveal a physical problem then medics will assume gout.
The colchicine test is not a perfect diagnosis for gout, but it is probably your best chance.
Let's get definitional: a gout attac is an EXTREMELY painful attack on a joint…emphasis on EXTREMELY.
There seems to be little point is dwelling on subtle and persistent DISCOMFORT.
Gout is most defintitly FAR beyond discomfort.Let's face it if we concentrate on ANY joint we can recall reall bouts of discomfort.
So a slight feeling of discomfort on walking is probably caused by humans deciding to walk on twos rather than all fours.
All foot pains are NOT gout nor are most knee pains gout.
Thanks everyone for sharing their thoughts. I agree that all the pains are not Gout and that's what confuses my situation more. At the same time, people having gout do experience symptoms similar to what I am experiencing( after-effetcs of Gout) – cjeezy symptoms are similar to mine. And I did got Gout attack, so there is reason to get these lingering pains.
I went to the Physio today and also showed to foot specialist. They feel it is mix of 3 things – Fracture, Gout and Mindplay( Like Zip said).
They actually let me do the thumb 360 degree rotation today and also let me pull my thumb out(stretch it). I could feel the buckling sound as well as the breaking sound as if the thumb is trying to pull out. So, there is element of the bone getting direct blow( my fracture was in the bone which directly links to the balls under the toe and it terminates near one of the ball. So, there may be still some internal swelling in that area not visible to eyes.
I have taken 200 mg Allopurinol for 4 weeks now(includes 250 mg for 2 weeks). Since last 2 weeks, my readings are near to 5. That might be helping to make my foot free as major improvement has happened only after I started 200 mg dose. But there may still be crystals causing the residual pains.
The doctor says that there are lot of stress related pains which we all get but the mind simply ignores them. With gout or injury, mind gets focused more on the minor stress related pains as well. Besides, we get into tendency of checking if it still pains and put extra pressure on the joints further stressing it. So, this is mind cycle, which makes us feel many pains which other people simply ignored.
All things seem to make sense but the fact is that there is still pain and its taking its own sweet time to go away. I do not know what else can I do except to continue with the current treatment and wait for the things to settle down.
You do seem to be getting better than average medical support in your posted case here.
I wish this was more general- as we seem to be a somewhat neglected fraternity most of the time.
This little community tries to re- address the problem ,at least.
If this is your first attack proper – then it is a shock. Most established gouties have learned to deal with pain and some major neglect from medics. I have had wonky looks from X-ray people when trying to mention gout as a factor in ankle problems- they just don't get it . We DO !
My personal suspicion on your situation is that there is a 3rd factor involved, apart from those mentioned- so I would keep an open mind and push for the best cover you can get from your medics right now.
The one 'unknown' is the impact of your AlloP treatment- which can re-trigger symptoms for some months still but at 5 mg/dl unlikely to persist for too much longer. If that is NOT soon the case, then a further factor must be implicated.
One final aspect is the hormonal angle:
If you're athletic and maybe slightly underweight- this may remove your natural protection provided by hormonal balance. This is the major stated reason for younger women gaining protection from gout attacks.
Hi Trev,
It is probably my second attack of Gout. First was 10 years back when I was exposed to -30 F temperatures for couple of months and my feet were in the snow for extended durations. The pain was very acute( like described in books) and full right foot was swollen like hell and could not be touched even by the bed sheet. I was directly given Allopurinol 200 mg on the day 3 while my foot was very painful. Allopurinol worked like a magic and the pain was 70% gone with first Allopurinol tab and went away completely in 3 days. In less than 7 days I was normal without any pains or swelling or any residual feeling of gout. I stopped Allopurinol after 3 or 4 months. There was no other medication, not even pain killers after 2 days of Allopurinol. I did not take any diet precautions in last 10 years though I am low on drinks and low on non-veg foods by choice. Some doctors say that it was not gout as Allopurinol at its own cannot cure the pain in 3 days. The symptoms were of gout though.
The current one is my second attack but in this case, my pain was not acute, it developed over a period of 3-4 days after the injury, very unusual way of getting the gout pain. May be gout pain developed due to injury happens this way.
You have a solid point. I am sure that Allopurinol is playing its part in correcting the problem while still attacking the root cuase(UA Crystals), which adds to some discomfort at times. I do feel itchy, burning sensations in my right toe( and at times left too). The doctor also told me the same thing that ignore these sensations unless they cause swelling or more than average pain. I have actually felt couple of weeks back that my foot was really sore before I went to bed with lot of twinges. Next mroning, my thumb movement was improved by more than 50% of the night before and foot was much more free.
I am not heavy athletic though till about a year back, I had my routine of 5-6 miles jogs min 5 times a week, which started hurting my knee and I started getting some ankle pains. That could have been start of Gout, can't say but everyone suspected too much of jogging was causing it. I also lost 30 lbs in 2 years and got my BMI down to under 20.
Lately, even before the gout attack and the injury, I have reduced the exercise to 2 miles jog with 2 miles walk for 3 times a week. I am not underweight but in the normal range. BMI near 22 to 23. So, I hope harmonal factor is not causing anything here.
I hope, it gives more information about my history of gout.
That's interesting.
Partial frostbite over extended periods must be as good a trauma as one can get to the feet and gout loves low circulations.
You don't mention any SUA taken at that time so it may remain an unknown as to gout status at the time.
Given the time lapse and the multiple injuries it will still take a bit longer to comb out what you're dealing with right now.
A classic case for the new Seimens double scanning technique discussed here a while back to show exactly what joint injury and aftermath exist.
If you can't see a specialist for a second opinion- then time will have to be allowed to produce its magic- hopefully.
It is dragging on longer than a usual gout attack , but yours is an unusual situation, also.
Doctors have limited knowledge of gout in general, though you have better advice than many- it's quite possible you have an 'early onset' type scenario caused by trauma which is presenting in an odd way and will likely resolve with adequate rest and contiuing lowering SUA.
That's the positive view -if you can't get that scan!
We're not medics here, all the same – but understand the problem only too well.
Hi Trev,
Actually, I have shown it to one GP and 2 foot specialists. Currently the GP and Podiatry, both are treating me.
As you rightly said, they have limited Gout knowledge and feel happy with the fact that UA is in normal range.
They are all more aligned towards bone fracture causing these residual pains as many of them are due to stretch under the toe bone and they feel the physiotherapy is helping. They are aligned that there was gout and I have to continue on Allopurinol.
I think, the fact that everything started with toe injury and Gout was slow to set in in a non-classic way, it creates some confusion, which I can understand.
I only hope that both the concurrent treatments that I am undergoing are complementing each other, not conflicting.
Not sure what the second treatment is you mention apart from rest and physio.
I don't think they would be detrimental administered by medics who know the basics, even if a bit perplexed by this one!
I badly crunched my right small toes in the dark last night and this morning along with the bruising were twinges on the left large toe -at the old gout site, previously settling down OK!
It's highly possible, that like with immune response going overboard in gout, healing processes can act 'broadbrush' , and differently, at various sites – but I'd be extemely surprised if much work has ever been done on this-say, to see if there's a clash between fracture healing and taking AlloP.
Generally in my episodes with gout, continual light use and movement not only keeps mobility- but acts as a mental lift to get you out of the doldrums- so persevere! But be patient
youtube,
Have you ever tried colchicine? In many cases it is diagnostic in that if it helps a lot the pain is gout; if it doesn't do much, it is NOT gout. This isn't infallible but it is GOOD evidence.
For non-gout aches and pains I STRONGLY recommend Alleve (or the cheaper generic naproxen.) In my experience it has no peers among the NSAIDS and we in the U.S. are lucky that it does not require an Rx. Pop 2 (200 mg. each) of them and you might be amazed.
(I wrote to Bayer and they told me their research also showed it to be good for gout pain without affecting serum uric acid…but I haven't used it for gout, I don't THINK. It works wonders on my knee and shoulder pain.)
trev,
Sorry you whacked your little toe last night, I have a tendency to do the same thing. My last was into a dumbbell left on the floor and, yes it's true, we CAN actually see stars.
Thanks Zip- I kicked a vacuum cleaner clear- about a foot, with 3 small toes straight on.
I wouldn't be suprised to find a fracture -but there's no treatment for this normally in small bones.
I'm just praying 'ol G' don't sniff out this new site*- I've only ever had it as far as the 'next to big toe' so far. I may treat you a pic of the bruising…
* [Don't worry, the Colch will be out if it does!]
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