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

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.

Treatment for Plantar FAsciitis

Pain in the heel area on the sole of the foot, is very disabling and may be due to a condition called Plantar Fasciitis. The plantar fascia is a structure which supports  the muscular structures on the sole of your foot spanning from the heel, forwards to the metatarsal heads which are on  the 'ball' of the foot.  This can contract and cause excruciating pain when you start walking especially after a period of rest or after an unusual activity such as ladder climbing.  There are exercises which can alleviate the pain caused by plantar fasciitis. They are based around stretching the calf muscles and the plantar fascia and must be performed within a pain free range. You should feel a pulling of the muscles, but not pain.  Exercise 1 Face a wall and stand at a distance of just less than arm's length. Place your hands against the wall at about eye level. Put the affected leg about a step behind your other leg, so that it is straight and the other one bent. Keep the heel of the straight leg on the floor and lean forward. You should feel a strong pull in the calf muscles. Hold this position for about 20 seconds and repeat 4 times. This should be repeated about  2 or 3 times a day and especially before exercise. Exercise 2 Sit down on the floor if you are able and stretch your legs in front of you. Place one end of the towel under your leg with the towel stretching along the length of the sole of your foot  and grab the other end of the towel. Pull the towel from the top of your leg so that the toes are pulled up towards you.  If sitting straight legged on the floor is difficult, this exercise can be adapted for sitting on a chair Roll up a towel and pull it around the toes of your affected foot, holding the towel at both ends.  Straighten your leg and pull the towel gently towards you.  Hold this position for about  15 seconds. Repeat it 4 times. There will be a pull on both the plantar fascia and the calf muscles. Be sure not to cause any pain. Exercise 3 This exercise can be done at any time of the day, especially when you are sitting down in the evening, whilst reading or watching TV. You can use a tennis ball, a can from the cupboard  or an empty bottle. When you are sitting, roll the ball with the arch of your foot back and forth from your heel to the toes. If you are using a ball, you can manipulate it in a circular motion as well. Do this often but stay within the limit of pain. Exercise 4 Using the bottom stair or step, hold the handrail for support and shuffle your feet backwards until your heel is hanging over the edge. Slowly, and within the range of pain, lower your heels below the level of the stair. Hold this position for about 10 seconds and slowly bring your heels back up. Then repeat slowly and carefully about 5 times If these exercises don't relieve the pain, it may be necessary to have a full biomechanical assessment. Orthoses  may be fitted into your shoes to alter the stretch on the plantar fascia and provide much sought after relief!

http://www.youtube.com/watch?v=YPvpvtXfkJI

Symptoms of Plantar Fasciitis

"The pain is worse when I get out of bed in the morning"

"It's strange. It's right in the middle of my heel - underneath"

"Sometime it hurts if I've been standing for  a long time"

"I can't put my foot down"

Plantar Fasciitis is a very painful condition. The pain is felt in the middle of the sole of the heel and is usually at its  worst, first thing in the morning . In the early stages of the condition, the pain may disappear after a few steps, but  sometimes it can become quite disabling and can last for a long time.

The plantar fascia is a structure which supports  the muscular structures on the sole of your foot.

It spans from a midpoint almost central on the heel, forwards to the metatarsal heads which are on  the 'ball' of the foot. The pain is due a pulling effect at the heel and, in the worst cases, inflammation can travel forward along the whole length of the plantar fascia.

It is very painful first thing in the morning, as most people sleep with their toes pointing down.  In this position, the plantar fascia contracts.  The next morning, when the toes are pulled up in order to start walking, there is an  enormous stretch on the heel, causing the pain.  Once the plantar fascia has stretched out, the pain may ease until there is another period of standing or inactivity.

The onset of plantar fasciitis is often associated with exercise that over-stretches the plantar fascia, such as climbing ladders, or anything that involves balancing on your toes.

In some cases the condition can become so severe that a heel spur may begin to develop where the plantar fascia originates.

If you have  these symptoms, you could very well be suffering from plantar fasciitis.