Items filtered by date: January 2019
Pain underneath the great toe can be a result of injuries to the sesamoid bones. These 2 semilunar-shaped bones are located beneath the head of the 1stmetatarsal and function similarly to kneecaps. These small bones that play an important role in the functionality of your toes by helping to absorb weight-bearing pressure at the joint, reducing friction at the metatarsal head and protecting the tendon that flexes the great toe.
A person experiencing sesamoiditis would experience pain beneath the head of the great toe. Pain is usually worse with walking or running and may be exacerbated when wearing high-heels or thin-soled shoes. Trauma to the sesamoids or positional changes of the bones due to biomechanics or foot structure may lead to pain. Sesamoiditis occurs more frequently in those with high-arched feet or people with bunions. Dancers and joggers also commonly experience sesamoiditis.
When examining your foot, your podiatrist will examine each sesamoid and the range of motion at the joint. Usually the tibial sesamoid, the more medial bone, will be more painful than the fibular sesamoid. If the joint is swollen your podiatrist may aspirate the joint to rule out gout or septic arthritis. There may be a callus or corn in the area, exacerbating or producing the pain. Your foot doctor may order x-rays to evaluate for possible fracture, displacement, or arthritis.
Conservative treatment for sesamoiditis include shoe gear changes to shoes with a thick sole and orthotics that would reduce pressure on the sesamoids. Corticosteroid injections may be offered to help reduce pain and inflammation. In the case of fractured sesamoids or refractory sesamoiditis, foot surgery to remove the sesamoids may be indicated. Call your podiatrist today if you have questions or concerns about sesamoid injuries.
Gout, once known as a ‘disease of kings’ is making a resurgence. With the rise of obesity and a trend of low carb diets such as keto or paleo, the incidence of gout is increasing and its becoming more prevalent in a younger cohort. Gout is an inflammatory arthritis that is a result of excess of uric acid. Hippocrates referred to it as ‘the unwalkable disease’ as the pain can be excruciating. The joint that is most commonly involved is the metatarsophalangeal joint of the great toe, called podagra. Other sites of gout attacks include the ankle, knee, elbow, or wrist. An acute flare of gout may present as a sudden onset of pain during the night and progressively worsen within hours. Often there is swelling and tenderness, the skin overlying may appear red, warm and shiny. Episodes may range from a few days to weeks.
Hyperuricemia, or elevated urate levels can be caused by either decreased excretion, increased production, or increased purine intake. The most common cause of hyperuricemia is decreased renal excretion. Decreased excretion may be a result of genetics, the use diuretics, or renal damage or disease. Increased ingestion of purine-rich foods such as organ meats, anchovies, herring, mussels, sardines, beer, and etc. can lead to hyperuricemia.
Definitive diagnosis usually requires aspiration of fluid from the joint to confirm the presence of urate crystals. Your healthcare provider may also order X-rays to look for erosions or tophi, especially if it is chronic issue. Acute attacks of gout are treated with Colchicine and anti-inflammatory drugs such as NSAIDs. Diet change and decreasing intake of purine rich food or drink may help lessen frequency of attacks. To prevent or decrease recurrence, your doctor may also prescribe Allopurinol to lower the serum urate level or Probenecid to increase the excretion of uric acid. Call your podiatrist today, if you have questions or concerns about gout and the treatment options available.
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