If you experience serious pain related to Gout, please Schedule an appointment with one of our orthopedic specialists as soon as possible.
What is Gout?
Gout refers to a metabolic condition characterized by hyperuricemia or having excess amounts of uric acid in your blood system (over 6.8mg/dL). Urate crystals form, accumulate, then the body typically
deposits the urate crystals into the coolest, most distal joints of the body, frequently in the big toe joint. Your body produces these crystals as it breaks down a substance called purines that typically
accumulate from your diet. Males experience a higher rate of gout than females. The average age of a person experiencing a gout flareup ranges between 40 to 50 years old.
Foods that elevate uric acid levels in the body include:
- Red Meat
- Fish (Herring, Tuna, mackerel, sardines, and anchovies)
- Organ meats such as liver or kidneys
- Shellfish such as mussels or scallops
Gout can affect more than one joint at the same time in some people. It can also happen in other joints, including the foot, ankle, knee, elbow, hand or wrist, or even small joints in your fingers. Gout may also affect soft tissues, like your joint capsules, sheaths around your tendon (Rope like tissues that connect bones together to help your joints move)
What are the Symptoms of Gout?
A “gouty” attack can manifest with an abrupt onset of a red, hot, swollen, and severely sharp and painful joint. Gouty arthritis occurs when the uric acid crystals in combination of inflammatory
markers destroy the healthy soft tissue, cartilage, and bone within a joint space.
Your foot and ankle specialist can diagnose gout in the foot or ankle by blood lab work, joint aspiration, or verifying a sign called the Martel’s sign on x-ray.
Treating gout includes taking anti-inflammatory medications to decrease acute inflammation to the affected joint and to suppress the development and deposition of gouty or urate crystals. Chronic gout treatment typically involves dietary identification and careful management of serum uric acid levels in the body with your primary care physician or rheumatologist.
In severe gouty arthritis cases, your foot and ankle surgeon may manage the joint pain with a surgical arthrodesis, or fusion procedure. It is important to treat gout early to prevent stress fractures from weakened bones caused by gouty inflammation.
First Metatarsophalangeal Joint (1 st MPJ) arthrodesis surgery.
In the big toe joint fusion, or first metatarosophalangeal joint arthrodesis, the surgeon makes a 4-5 cm incision over the great toe joint. The surgeon examines the joint, removes all excess urate acid
crystals, diseased soft tissue (joint capsule), and prepares the joint for fusion. The surgeon then aligns the first metatarsal bone and the phalanx bone of the big toe together anatomically with a
plate and several screws for internal fixation.
Recovering From an MTP Joint Arthrodesis.
After the surgery, patients will find their foot bandaged and numbed, and go home with a padded shoe and an assistive device if necessary. They will do light exercises at home to strengthen the foot and speed up recovery time. As an outpatient procedure, most patients will go home from the hospital with some painkillers the same day as the operation, after setting up a follow-up appointment.
During the first few weeks, your physician will suggest patients rest their foot, keep it elevated, and take the prescribed pain medication.
Healing and post-operative strategies tend to vary from person to person. Typically, thepostoperative healing schedule follows this pattern:
At two weeks your physician will remove your bandages, remove stitches, and examine the foot.
At six weeks the physician will examine the foot again with X-rays to make sure it heals properly.
At 12 weeks the physician will give one final check before fully discharging you.
How Soon Can I Walk After a First Metatarsophalangeal arthrodesis surgery?
Your surgeon will advise you about the type of footwear you should use and how quickly you will recover.
Weeks 0-2 will require light activity and partial heel weightbearing with a prescribed short protective walking boot or hospital shoe.
Weeks 3-6 will gradually return to normal activity after the doctor has completely removed the bandages and stitches.
After six weeks – you can walk in comfortable fitting shoes.
What is Pseudogout?
Pseudogout involves a different condition affecting the joint spaces known formally as Chondrocalcinosis or Pyrophosphate Arthropathy. Pseudogout is characterized by deposition of calcium pyrophosphate dihydrate (CPPD) crystals, distinguished by arthrocentesis and
joint or synovial fluid analysis.
Clinical features of pseudogout may include a red hot, swollen, and severely painful joint. However, the majority of patients with CPPD rarely experience the aforementioned acute attacks. Additional
CPPD symptoms include morning stiffness, fatigue, and restricted joint motion. Males and females have an equal chance of experiencing chondrocalcinosis. Commonly, patients suffering from
chondrocalcinosis can also experience hyperparathyroidism, acromegaly, arthritis in other joints, diabetes, and hypomagnesium.
The knee joint most commonly suffers from CPP arthritis. Other joints commonly affected by Chondrocalcinosis include the spine, wrist, metacarpophalangeal joints, and the pelvis.
On X-rays, your physician may distinguish pseudogout from gout by the appearance of calcified cartilage surfaces.