Gout

Gout has a very long history. Hippocrates (c. 460 – c. 370 BC) identified gout (Greek: podogra) as different from other forms of arthritis. It is a member of the family of arthritides, it is inflammation of joints, but it differs because it is caused by the build up of monosodium urate crystals. These are often referred to as uric acid.

Two very brave gentlemen, Faires and MacCarty, investigated the role of these crystals in gout during the 1960's by injecting their left knee joints with them. Within four hours they were experiencing violent attacks of gout and the pain was excruciating.

Surveys have found that gout is an agonising and incapacitating form of  arthritis which "negatively affects daily activities, lifestyle and work "  (N. Lawrence Edwards, MD, Professor of Medicine, Rheumatology and Clinical Immunology, University of Florida College of Medicine) Flare ups are sudden, intense and last an average of 8 days.

Gout sufferers usually produce too much uric acid or are unable to get rid of the excess produced by their bodies. The uric acid forms needle-like crystals which are deposited in the joints. It typically affects one joint, often the big toe (62% of cases) and it can also cause feverish symptoms.

The presence of the crystals trigger an immune response, leading to  inflammation;  joint swelling, pain, heat, redness and stiffness. In some patients the condition can become chronic causing repeated flare ups, joint damage, kidney stones and kidney disease.

Gout tends to run in families, affects about 1% of the population and, it is more common in men than women.

For a long time, alcohol has been considered a trigger for gout attacks.  Little research has been carried out in this area, although one recent study on 197 subjects found that alcohol can  trigger recurrent gout attacks, usually occurring within 24 hours of consumption.

Dehydration is another factor often associated with gout. During periods of increased perspiration, less uric acid is excreted and so at times of high humidity and high temperatures, those prone to gout should drink lots of water. 

A very interesting paper in 2007 (Arthritis Rheum. 2007;56:2048-2054,) connects a reduced incidence of recurrent gout attacks in men over the age of 40 with coffee drinking,

"A study of a nationally representative sample of US adults showed that coffee consumption was associated with a lower serum level of uric acid and a lower frequency of hyperuricemia."

Many gout patients are managed with Allopurinol, the urate lowering drug, with varied success. Allopurinol will not work during an attack as it is not a painkiller and, it may take up to 3 months to be effective against another episode.

If you are unfortunate enough to suffer with gout, one of the most painful conditions known, please reduce your alcohol intake and  increase your fluid levels, especially in hot and humid weather.  Your GP can prescribe painkillers for use during an attack; it's worth paying a visit.

For more information on Podiatry, click here: The Footcare Clinic

Ingrown Toenails

The very thought of a true ingrown toenail is enough to my toes curl! (More on curly toes later!)  It is a very painful condition and by the time a patient seeks help, it is often very inflamed and even infected.

Some people are prone to ingrown toenails, due to the natural shape and condition of the nail plate. Others are unlucky enough to suffer trauma to the nail, which causes it to ingrow.

If your nails are very 'tight', almost like a staple, they are possibly 'involuted'.  This type of nail is often inherited and extremely difficult to cut.

 Attempts to cut these nails may leave small spikes down the sides and, unfortunately, they only become apparent when they start causing pain.  The spike of nail literally grows into the flesh at the side, in the sulcus. At first it is only a slight irritation, but very quickly it rubs, pierces the skin and sets up an inflammatory response. As there is a lot of bacteria present, both in and around the nail, it soon becomes infected.

The skin is an incredible organ and as we all know, makes every attempt to heal itself.  Ingrown toenails are no exception.  The inflammatory response encourages the body to repair the skin break, delivering more blood to the area.  The next stage of the healing process is granulation of the wound. This is when a matrix is laid down in the wound for new capillaries to grow.

With a spike of nail present, the wound can't heal.  The body reacts to this by trying to 'reject' the foreign object and produces more granulation tissue, until there is 'hypergranulation' tissue. 

This is a lump which rises above the level of the surrounding skin.  It isn't painful itself, but it does bleed very easily due to the number of blood vessels present.  This is the stage when people usually seek help as looks quite alarming in addition to the pain.

Your GP will often prescribe antibiotics for this, which will help if there is a bacterial infection present, but will not resolve the problem. The only way to 'cure' the ingrown toenail is to have the spike removed.

This is not as painful as it sounds, even if the toe is very sore. An experienced podiatrist can resolve the problem in a matter of minutes, once the location of the spike has been found.

Once the spike has been removed, relief is immediate. The hypergranulation tissue will usually shrink back within hours and the toe will heal completely within days. 

A very easy resolution to a very painful condition!

Incidentally, the medical term for an ingrown toenail is 'onychocryptosis'. A very suitable name for a condition which is crippling.

So, if you think you have left a spike of nail when trimming your nails or have knocked your nail and think it may have split, hot foot it to your podiatrist who will sort you out in no time :)

Tendonitis

Cure Tendonitis In Seconds

 "Tendonitis" the doctor said. "There is no substitute for rest and gently working your way back to full exercise.  Use a support bandage and if the pain gets too bad, then take some pain killers".

The patient though, was a self employed swimming teacher and  life guard for whom 'rest' wasn't an option. Well, not if she wanted to eat!

 So, it was time for physical therapy, not pills. She saw a practitioner who smiled and agreed that the problem could be resolved in a matter of minutes.  The patient was doubtful.  "I've had the pain in my knee for nearly two weeks and I can hardly bear to walk on it"

The therapist explained that she was going to use the Jones Strain Counterstrain technique.  This is a simple process which was explored fully by Dr Lawrence Jones, an osteopath, in 1955. The theory is that pain occurs when a muscle is forcibly stretched as it is trying to contract. This produces a physiological response which results in inflammation and restricted joint movement, often at the muscle tendon - known as tendonitis.

The simple procedure involved the patient relaxing on the couch whilst the practitioner found the 'sore spot'.  Then with constant feedback from the lady about the level of pain, the practitioner slowly straightened the leg with her finger on the 'sore spot' all the time.  When the patient reported that there was no pain, the practitioner held her finger on the spot, keeping the leg in the optimum position, for 90 seconds.

Once the time had elapsed, the patient straightened her leg, bent it and said,

"That's incredible. There is no pain at all"; The tendonitis had gone!

And the happy ending was that the lady went back to work the same day, took no painkillers, needed no strapping and was able to buy her tea!

Here is a YouTube video which explains treating Foot/Calf Pain with Gentle Technique.