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Gout

Gout is a type of arthritis. It results from an excess of Uric Acid (the waste product formed from the breakdown of food and protein) in the blood, which if present long enough, can form into needle-like crystals which can inflame your joints and cause severe pain and swelling. This accumulation of uric acid typically occurs when the body has difficulty processing certain protein substances called Purines that are found naturally in our diets. Your diet plays an important role in both causing gout and in reducing the likelihood of suffering further painful attacks.

Foods Highest in Uric Acid (AVOID THESE):

- Anchovies
- Sardines
- Mackerel
- Sweetbreads (veal, lamb, pork)
- Kidney
- Brain
- Liver
- Scallops
- Meat Extracts (consommé, Oxo)
- Mussels
- Goose
- Herring
- Fish Roe (caviar)
- Yeast containing foods/drinks (BEER/Marmite)
- Wine
- Gravies
- Heart
- Game (rabbit, venison, pheasant)

Foods High in Purines (LIMIT These – No more than 1 serving a day):

- Eel
- Peas
- Cauliflower
- Lentils
- Beans
- Asparagus
- Mushrooms
- Other shellfish (crab, shrimp)
- Whole Grain Cereal
- Whetgerm & Bran
- Trout
- Poultry (chicken, duck, turkey)

Foods Lowest in Purines (GOOD to Eat – in Moderation):

- Milk
- Nuts
- Eggs
- Cheese
- Chocolate
- Ice Cream
- Pasta/Noodles
- Cake
- Refined Cereals
- Vegetables (except noted above)
- Spices/Condiments (salt/vinegar)
- Butter/Margarine
- Biscuits

SYMPTOMS

Gout usually starts with a sudden onset of intense pain in 1 or more joints, usually the big toe joint of the foot. The pain is accompanied by redness, swelling, and warmth over the joint. Other common sites are the instep of the foot, the ankle, or the knee. When the foot is involved, wearing shoes is difficult and painful, as are attempts to stand on the foot.

DIAGNOSIS

The diagnosis is based on a personal and family history (gout can be hereditary), as well as clinical examination of the affected area. Blood tests are often performed to determine uric acid levels. Sometimes, the joint fluid is examined to look for uric acid crystals. X-Rays also may be performed to examine the bones/joints to rule out abnormal changes associated with gout.

TREATMENT

The treatment of gout begins with making the proper diagnosis. Oral anti-inflammatories are most often used to manage the acute attack. While over the counter drugs may reduce symptoms, they are rarely strong enough to treat the acute pain, swelling or inflammation. Prescription anti-inflammatories may help as well as steroid injections to reduce pain and swelling. If the gout attack is in the toe, it will help to elevate the foot, avoid standing or walking, and wear a loose slipper until examined by a podiatrist. It is important that your medical doctor establish which of the two primary causes (producing too much uric acid or not eliminating it properly) is involved in order to treat the gout long term. If gout attacks continue despite medical treatment, if there are excessive deposits of gouty crystals within a joint, or if arthritis causes continual discomfort, surgical treatment may be necessary to remove the crystals (tophi) and repair the joint.

Important Questions


Can losing weight help my gout?

If you are overweight, gradual loss of weight will help you reduce the level of uric acid in your blood and reduce the stress on weight-bearing joints (hips, knees, ankle, feet). However, it is important to avoid any type of crash dieting, as going without food fro long periods and rapid loss of weight can increase urica cid levels and trigger painful gout attacks. A combination of balanced healthy eating and regular physical activity is the best way to lose weight safely and maintain your weight at an optimum.

Are there any foods which are good for gout?

Scientific studies have confirmed the long-held belief that the consumption of cherries/Cherry juice can be beneficial.

Can I drink alcohol?

Drinking alcohol can increase your risk of developing gout and can bring on a sudden attack if you are already a gout sufferer. Alcohol can raise the level of uric acid in the blood in a number of ways and so trigger a gout attack. Many beers contain large quantities of purines from the fermenting process and alcohol stimulates the production of uric acid by the liver. More importantly, alcohol is converted in the body to lactic acid which interferes with the removal of uric acid from the body by the kidneys.

Should I drink lots of water?

Yes, drinking fluids reduces the likelihood of crystals forming in the kidneys. As a general rule, drinking 8-10 glasses of water a day is recommended.

Hammertoe: No Walk in the Park!

Hammertoe: No Walk in the Park!

Hammertoe is a painful deformity of the second, third, or fourth toe, frequently caused by improper mechanics—the way a person walks or the shoes they wear that do not allow room for the deformity. Similar to mallet toe and claw toe, hammertoe involves different joints of the toe and foot. Shoes that are too narrow or short for the foot, or have excessively high heels, can cause hammertoe. Improperly sized shoes force the toes into a bent position for long periods, causing the muscles to shorten and bend the toes into the hammertoe deformity.

Other causes of hammertoe may be complications from RA (rheumatoid arthritis), osteoarthritis, trauma to the foot, heredity, or CVA (cerebral vascular accident). Symptoms of hammertoe include, but may not be limited to, pain and difficult mobility of the toes, deformity, and calluses or corns from toes abrading one another.

A patient experiencing symptoms of hammertoe should seek examination by a physician, specifically a podiatrist. Podiatrists diagnose and treat disorders of the foot. If the doctor finds the involved toes have retained some flexibility, treatment may involve simple exercise, physical therapy, and a better fit to shoes worn by the patient. Treatment often targets controlling the mechanics, such as walking, that cause hammertoe by using custom orthotics.

In more advanced cases, where the toes have become rigid and inflexible, the doctor may suggest surgery. The operation would consist of incising the toe to relieve pressure on the tendons. The doctor may re-align tendons and remove small pieces of bone in order to straighten the toe. The insertion of pins may be necessary to fix bones in the proper position while the toe heals. Usually the patient is able to return home on the day of surgery.

If surgery is necessary, it is important to follow the postoperative directions of your physician. Theses may include various stretches, attempting to crumple a towel placed flat against your feet, or picking up marbles with your toes. Striving to wear shoes with low heels and ample toe space will ensure healthy feet and toes. Avoid closed shoes and high heels. Laced shoes tend to be roomier and more comfortable. Shoes with a minimum of one half inch space between the tip of your longest toe and the inside of the shoe will provide adequate space, relieve pressure on your toes, and prevent hammertoe from re-occurring.

Some tips on feet may include purchasing shoes at mid-day as your feet are smaller in the morning and swell as the day progresses. Ensure that the shoes you buy are both the same size and have the store stretch shoes at painful points to provide for optimum comfort.

Bunions

Bunions

The term bunion refers to an enlargement of the base joint of the toe, the connection to the foot. This enlargement may be formed of swollen tissue or a bony growth, and is caused by the shifting of the bones in the big toe inward, toward the other toes of the foot. The area around the base of the big toe may become inflamed, red, and painful.

Genetic factors are important in the formation of bunions – people who get bunions are usually genetically predisposed to this bone displacement, and may cause its onset by wearing improperly fitting shoes, or by running or walking in a way that causes stress to the feet. Another common cause for bunions is wearing high heeled shoes. The weight of the body in these shoes pushes the toes into an unnatural position, possibly causing bone displacement.

Visiting a podiatrist who specializes in foot structure and bio-mechanics can quickly diagnose bunions. Bunions must be distinguished from gout or arthritic conditions, so blood tests may be necessary. The podiatrist may order a radiological exam to provide an image of the bone structure. If the x-ray demonstrates an enlargement of the joint near the base of the toe and a shifting toward the smaller toes, this is indicative of a bunion.

Wearing wider shoes can remove the pressure on the bunion and reduce pain. High heeled shoes should be eliminated for a period of time as this type of shoe generally pushes the big toe outward toward the smaller toes. This may be enough to eliminate the pain associated with bunions; however, if pain persists, anti-inflammatory drugs may be prescribed. Severe pain may require an injection of steroids near the bunion.

Orthotics for shoes may be prescribed which, by altering the pressure on the foot, can be helpful in reducing pain. These do not correct the problem, but by eliminating the pain, they can provide relief.

For cases that do not respond to these methods of treatment, surgery can be done to reposition the toe. A surgeon may do this by taking out a section of bone, or may rearrange the ligaments and tendons in the toe to help keep it properly aligned. It may be necessary even after surgery to wear more comfortable shoes that do not put undue pressure on the toe as the big toe can easily move back to its orientation toward the smaller toes.

Athlete's Foot: The Sole Story

Athlete's Foot: The Sole Story

Do you suffer from itching, burning, dry, and flaking feet? It could be athlete's foot. Athlete's foot, also known as tinea pedis, can be extremely contagious, often infecting shower floors, gyms, socks and shoes, and anywhere else feet might contact. It's commonly found in public changing areas and bathrooms, dormitory style living quarters, around locker rooms and public swimming pools. "Commons" areas in prisons and residential care facilities are frequently caught feeding the fungus as well. One step in the wrong direction can be enough to start the fire that can be tremendously difficult to treat.

Athlete's foot is most often caused by the same fungus that causes ringworm (tinea). It can be spread by direct contact with an infected body part, contaminated clothing, or by coming in contact with other objects or body parts that have been exposed to the fungus. Although the feet are more frequently assumed to get athlete's foot, tinea can invade other parts of the body as well so long as the proper growing conditions are met.

Tinea thrives in a dark, warm, and moist environment. Body parts that are often infected include the hands, groin, vagina, and scalp. Although many people never experience athlete's foot, around 70% of the population suffers from tinea at some point in their lifetime. Like most ailments, some people are more likely to acquire this fungal infection than others. People with a history of tinea or other skin infections are more likely to suffer from recurrent, or even additional, unrelated infections. The extent to which a person is tormented by the fungus can vary greatly as well.

While some people are never even aware that they have been infected with athlete's foot, others are pestered with mild to moderate symptoms like dry and flaking skin, itching, and redness. Still others are bothered by more severe symptoms including cracked and bleeding skin, intense itching and burning, and even pain when walking. In the worst cases, tinea can cause blistering as well.

The treatment for athlete's foot begins with prevention. Changes in the environment infected with athlete's foot can prevent spreading. Keeping the area that is infected clean and dry with the use of medicated cleansers and powders is essential. Allowing the area to breathe is important in the treatment as well. Exposure to cool air and light can make conditions undesirable for tinea. Treating the infected area with miconazole, tolnaftate, or other medicated creams, ointments, or sprays not only helps to kill the fungus, but helps prevent recurrences as well. White vinegar-based foot soaks can also be beneficial. Seeing a podiatrist is often a good idea when treating athlete's foot, since more often than not, other skin infections can develop from the initial infection, and recurrences are common.