Advice please

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My left foot has been very painful for weeks now. It is swollen, red and painful to walk on. The pain is located at the top of the metatarsal area of my foot, but can be sore on the ball of my foot. I have tried resting, pain relief, anti inflammatory tablets and massage balls, unfortunately its getting worse. I have not been to my GP as i feel they have enough right now with the current covid19 situation. Someone had said that i may have gout. I have never experienced gout or seen gout before so I do not know what i am looking for. Can someone advise me of what i should do?

AABB

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  • Posted

    Sorry - that's super frustrating and it's very difficult to not be able to see a doctor as normal. It might be worth scheduling a virtual consult or phone consult with your GP - they will likely send you for some blood tests if they think that it's gout. If it's gone on for weeks and is getting worse not better - I'd be skeptical that it is gout. Usually gout flares come on in a few days and then are excruciatingly painful for several days and with rest and lots of fluids and antiinflammatories they do subside. When they get really bad they can go on for longer but if this is your first experience it's unlikely for it to last weeks.

    Some things to think about.... did the pain come on suddenly overnight? What is your age and diet and underlying health? (If you are young and healthy it doesn't mean you can't get gout - a lot of it's genetics, but it's more common in older men with other underlying problems like overweight, poor diet etc.). Do you remember injuring your foot? Stubbing your toe? Pushing off your foot and feeling sharp pain? Tripping over something etc.? Is the pain severe, hot, throbbing, worse at night? What kind of mobility do you have in that joint? Is it the joint itself or the soft tissue and tendons around the joint? Does the pain get better when you ice it or worse? Does heat help? What kind of footwear do you use? Have you been on your feet more than normal and in uncomfortable shoes?

    If it's the big toe area that's tender and hurts as you push into the ball of your foot - get an x-ray and make sure they check your sesamoid bones for fractures. If it continues to hurt down the road you'll need to get yourself in for an MRI and then into a podiatrist. If you do get blood tests for uric acid make sure you do follow up bloodwork in another few weeks time to see if the uric acid is stable (it can go down during a flare as the uric acid precipitates out as urate crystals which is what causes the pain and inflammation known as gout).

    Good luck!

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  • Posted

    Although I've never had either officially diagnosed or treated, I'm reasonably sure I've had both gout and pseudo-gout, each more than once, and maybe even both together.

    With "real" gout the pain is so much worse you don't talk about it being "sore", and most of the time it starts in the big toe.

    With "pseudo-gout" it's much more likely to affect different areas, it can move between joints in under an hour, and the high metatarsal area makes it more likely to be pseudo-gout.

    Real gout is caused by uric acid crystals, responds to drugs like allopurinol and celery seed (xanthine oxidase inhibitor), pseudo-gout does NOT.

    It is very difficult to get clinical proof of which you have, normally they'll listen to your symptoms, touch you and listen to you complain, take a quick measure of your blood uric acid levels, and then guess.

    Get a list of high purine foods to avoid if it's gout (purines turn into uric acid), and avoid them like the plague. Get some celery seed, as a spice, as capsules, or even just eat a bunch of celery! But apparently there are NO KNOWN TREATMENTS for pseudo-gout. It should clear within a week or so, but it leaves behind bruises that can take another couple of weeks to clear.

    And if it doesn't, then go see a doctor, of course! At least it's your feet, you don't have to cough on anyone, LOL.

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  • Posted

    First of all. Are you male, and what is your age? Also this did not begin after an injury I guess? What other medication are you taking (there are many that can cause gout)? An attack of two weeks would not be unusual with gout; longer is not unknown without treatment.

    In the immediate, begin to drink as much water as possible; if its gout it will definitely help, and if its not it won't harm you. Hot or very cold (ice water) or a mixture of both would help gout. Ibufren helps with gout. Aspirin would make it worse.

    I would get a GP appointment or see your local pharmacist. They cant do any blood test to confirm if its gout until a few weeks after the pain has subsided. In the short term your doctor will give pain killers and maybe colchicine which would help gout.

    For a diagnosis and long term treatment of gout the doctor needs to see two attacks in 12 months.

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  • Posted

    Thank you all for your comments. I have just had a phone consultation with my GP. she said she thinks it is tendonitis. To meds for week or two then get back to her if it doesnt help as she may do a blood test to check for gout. I am a 49 year old female.

    aabb

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