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Hi all , Newbie Wizza here.
I 've been pretty active all my life, rugby, martial arts, running, cycling, swimming…
Recently diagnosed with a fractured sesamoid (in the same toe that I was told I had gout attack in mid 90's). Can't train as the pain and swelling prevents walking, you all know the pain.
Mid 90's I was told ” high uric concentration at 0/6mmol/l (normal range 0.15 to 0.43) and high 24 hr urinary excretion of urate at 5.8mmol/24hr (3.4-4.2) Renal function excellent. Cholesterol and subfractions normal. Red cell count borderline elevated 5.57 (4.5) with normal haemoglobin, keep an eye on this along with blood uric tests”
I was put on 100mg Allopurinol for 34 months, increasing to 300mg until blood uric normal for 6 months reducing to 100mg for long term with aview to coming off and monitoring every 3-4 months.
That was then and seems like a lifetime ago…
For tha last 3 years or so I 'v had pain in my toe/ball of foot when doing high impact training (Kung Fu , sprints, bouncing through surf for body boarding..) Presented to my Dr who gace pain killers , no refernce to gout. Got fed up and went to hospital , told it didn't seem like gout. Went nack to Dr, got referred to Rheumatologist who was laready treating me for elbow problem. He knew about my gout diagnosis. The Mri on elbow revealed a 5mm piece of bone probably causing the imflamation, cortisone…. I also showed him my swollen foot . He does my bloods again and they come out high end of normal… MRI and X ray show damage to sesamoid bone in same toe as gout attack in 90's. He referrs me to a consultant podiatrist, he says fractured sesamoid and nothing to do with gout.
I don't think I have had a gout attack, but I havfe booked back in with my Dr to have my bloods tested again.
1) Home kits , are they any good at testing your blood urics levels, are they worth having?
2) I've not had allopurinol for 12 years, is that a problem?
3) Does anyone else have an injury that masks/relates to gout?
I've been cast for orthotics for the sesamoid injury , I just hope that's the end of it. Anyone else had a similar experience?
Wizza
I had similar experience though my fracture was in the bone next to Sasamoid. I bumped my big toe against the bedpost very hard, which resulted in full toe nail turning black due to blood deposit. 3 days after that, I got increased pain in the toe, which was diagnosed as Gout( though doctor is still not sure if it was gout). It took 6 weeks to determine if it was gout or frature or both. Final dignosis – Both. The trigger for Gout – toe injury.
But my symptoms were similar to yours. Could not put my foot down, I was put on post op shoes, and it took its time to heal( still in the healing process as the area around sesamoid still pains when I walk barefoot or when I get up after sitting for a while). I was very active, doing a lot of jogging and running but it has put a stop to a lot of my activities( though I am getting back to them slowly).
What makes my doctor believe I had gout – Uric acid level of 9 before I start Allopurinol and Colchicine was helping in reducing pain and swelling. Besides that, I did not have the classic Gout symptoms. And I did not have pain anywhere else except the injured big toe.
Currently, I am taking Allopurinol for last 3 months (current dose of 300 mg a day)and that has got my Uric Acid levels down to 4 within few weeks. I am also doing Physiotherapy to help the injury /fracture.
The recovery is taking time but I am told the fracture in this area takes time to heal and the residual pains can take up to a year to fully go away. Sesamoid still pains at times. I am using orthotics and a sleeve to support the toe (given by the podiatrist), and that seem to help to some extent
I am using Uric Acid test machine at home and find it very useful and accurate( compared with lab 4 times and found the results consistent).
Here's good pic that shows you can nearly break a toe and NOT trigger gout!
I'd forgotten how to get a pic on here- It's hardly obvious- but I hope it makes you say Ouch and Congrats at the same time :0
I kicked my vacuum cleaner about a foot+ across the landing, in the dark.
[ Yeah, I wander bare footed at night!]
On a technical note- the big toe shows the site of my last attack- must have been 2 years ago that side. My last 2 attacks were on the left ankle and big toe. No meds. 7.5 mg/dl.
I guess Gout loves Big Toe….more so if it gets fractured.
But anyway, you are lucky to avoid it, even though it was not big toe…the hit seemed hard.
I do not have the pictures but my nail on big toe went all black…with the new nail grwoing, the black portion has got reduced( due to nail cuttting) but still 30% of nail on the top is black.
Wizza, If you are being treated for gout by someone who thinks .43 is normal, you are being treated by a sadist.
Irrespective of your injury, you need to control your uric acid properly.
Fractures usually heal eventually. Untreated gout will just cause you increasing musculo-skeletal problems as you get older.
Home kits are OK, but what you really need is a doctor who knows gout – or at least train yours to keep your uric acid under .35 mmol. To clear your uric acid crystal buildup, you need to aim much lower than .35 for at least 6 months.
As well as the Uric Acid Levels page I just referred to, you and your doctor also need to read the related page from the Reference menu above – Uric Acid Levels – which explains scale conversions and decries “normal”.
Hi all, bit of an update. I've been having bouts of pain brought on by activity, walking , coaching rugby (no real sports activity). Been backwards and forwards to consuultant podiatrist. I begged for an air cast to help me walk when I had pain. That caused more problems because it made me mobile and I over did it causing ankle and achilies problem. Had full bone scan, sesamoid injury shows up like a bright star. Podiatrist concerened at the clour of my injured foot , it looks purple and swollen compared to the good foot. He also said the injury is years old and the sesamoid has atrophy. I am beside myself with the stress of this. I was told years ago that my pain was gout , but I had a broken bone that has now died! The payyern of pain seems to follow any prolonged walking/standing or ballistic movement involving my forefoot. By the end of a working week my toe is sore, add the weekend gentle activities and by the following Monday evening/Tuesday agony.The less active I am on my feet, the less pain. Swimming seems to be the only activity to keep my sanity , (must watch the push offs though!).
I have been referred back to rheumatologist as the podiatrist thinks there might be Chronic Regional Pain Syndrome . Rheumotologist thinks no CRPS and we agreed to try and eliminate gout as best as possible by going on allupurinol 100, 200, 300 mg increase fortnightly for 6 weeks, get urates to 300. If I still get the pain and symptoms then hes says it should rule out the gout. Podiatrist says he will inject the toe to help fix the pain. I won't take the injection until the Allupurionol trial is complete. Rheumatologist is not convinced of gout either, as he reminded me that when he saw me when I had an episode he injected me in the rear (with ?) and it didn't sort it out.
There, that's got it off my chest and I feel better for it!
Please can you tell us the name and address of your rheumatologist so other people might avoid him.
Fixing gout with an intramuscular injection of something (wish you could remember what)!!!, or a 6 week run on allopurinol!!!
No wonder people mistrust doctors.
Believe it was depo-mendrone . We are trying to eliminate the gout as causing the severe reaction in the sesamoid;what's the problem with doing the 6 week allupurinol and reviewing the blood urate? If I still get the symptoms if the urate is lowered it would point to the problem being something other than gout? I may have to stay on the allupurinol and keep reviewing the urate. It is a trial period to try and eliminate the gout from the equation o the reaction to my foot swelling up when the broken sesamoid is overused.
Depo-Modrol? That steroid is supposed to be injected into the affected joint, though you wouldn't see me accepting it (steroids work against your natural pain management process). No wonder it did nothing for the gout.
It is perfectly normal to do 6 weeks allopurinol, then test blood urate. I wish all allopurinol doctors would do it. However, all that does is set you up for the uric acid crystal removal stage, around 6 months if you get your dose right. Only when all urate crystals have dissolved can you remove gout from the equation.
Either, you have misunderstood your rheumatologist, or, he is incompetent.
Hi Wizza,
Your case is very similar to mine as we seem to have multiple syndrome symptoms. I also had a fracture that was in the bone connecting to sesamoid. That caused swelling in the sesamoid and it was hurting as I was putting my foot down…I could clearly feel pains in them as I used to walk. The post op shows helped me and it took couple of months for the pain to go away. Other area of pain was in bending the toe upward.
In the mean-time, gout was also suspected as Uric acid was high at 9.2 and Colchicine helped though the doses were small.
I have taken Allopurinol for 4 months, 300 mg for last 2 months and it got my Uric Acid down to 4 for last 2 months( less than 5.5 for 3 months now)
The pain is still there though it is only in the toe bending upward. It is very difficult to rule out one thing or the other and it is possible that they had been feeding each other. As such, I continued with treatment for fracture and Gout both. Things have improved and I hope to get better in the coming days.
Gout Pal , thank you.
I'm sure I have understood what the consultants are trying to do, I am aware that I cannot just come off the allupurinol. I would not be surprised if gout and a broken sesamoid are playing their part.
“Fractures usually heal eventually” I've been told that mine won't heal as it has atrophy. The injury is years old and has been overlooked because of the earlier gout diagnosis. I was given indomec/dicoflex and other drugs to mask its pain. None worked. Since returning from Shaolin in May i have persevered with trying to tell consultants that I am not having a gout attack and that something else is wrong and has been wrong for years.Eventually MRI showed the fracture. It has caused me an incredible amount of pain.
I'll keep you posted of developments that might help others in a similar situation. Gout Pal's input on the correct course of treatment can be used to guide your consultants.
Sesamoids are a pain in the ass becasue they are so small but so necessary. Hard to believe any bones so small as the toe sesamoilds can fracture, but they do. There is little they can do except put them in a long term cast (a pain) or remove the broken fragments which can destabilize the joint…not so bad if they leave ONE of the two. I guess all those martial arts kicks took their toll. Have they considered removing the one broken and/or dead sesamoid? Toe stability can be mainted with just the one remaining good sesamoid. Can they put a prosthesis in??? (Don't know if foot surgery has gone that far yet.)
Anyhoo,
I was put on 100mg Allopurinol for 34 months, increasing to 300mg until blood uric normal for 6 months reducing to 100mg for long term with aview to coming off and monitoring every 3-4 months.
That treatment plan was nightmarishly awful. Allopurinol is NOT for dosing until one can get a couple good SUA readings with an eye towards stopping. One commits to allopurinol for life; gout just doesn't go away, it is not like a bout with influenza, more like diabetes. Long term gout erodes the joint bones of the foot and perhaps this erosive process weakened your sesamoid and made fracture easy with one wrong kick
Gout seems to LOVE foot fractures and congregates right to them complicating healing.
BTW,
Podiatrist concerened at the clour of my injured foot , it looks purple and swollen compared to the good foot.
That's EXACTLY what a foot looks like in the midst of a gout attack.
I STRONGLY recommend you start taking 300 mg. allopurinol immediately if you are not already doing so. Don't bother with the 100 mg low dose nonsense because you already know you can tolerate the drug.
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