Diseases Treatment

What is this Condition?

Gout is a metabolic disease marked by localized deposits of uric acid salts that are normally excreted through the kidneys. The deposits cause painfully arthritic joints. Gout usually strikes the feet and legs of men over age 30 and women past menopause. In elderly people, it is linked to other diseases.

Though gout may disappear for years between attacks, it can lead to disability or crippling. Fortunately, most people get better with treatment.

What Causes Gout?

Although the exact cause is unknown, gout seems linked to a genetic defect in metabolism, which causes overproduction and retention of uric acid. Too much uric acid leads to urate deposits in the joints or tissues, causing local damage. Secondary gout, linked to other conditions (such as obesity, diabetes, high blood pressure, sickle cell anemia, and kidney disease) or to drug therapy, produces similar harmful substances.

Another condition, called pseudogout, or chondrocalcinosis, causes arthritic pain too, but for different reasons.

What are its Symptoms?

Gout develops in four stages (asymptomatic, acute, intercritical, and chronic) that produce the following findings:

• In asymptomatic gout, urate levels rise in the blood but produce no symptoms. Later, gout may cause high blood pressure or show up in severe back pain.

• The first acute attack strikes suddenly and peaks quickly, causing extreme pain in one or only a few joints. Affected joints feel hot, tender, inflamed, and look dusky red or bruised. The joint of the big toe usually becomes inflamed first, then the instep, ankle, heel, knee, or wrist joints. Some attacks pass quickly and then come back at irregular intervals. Severe attacks may last for days or weeks.

• Intercritical periods are the symptom-free intervals between gout attacks. Most people have a second attack within 6 months to 2 years, but others are symptom-free for 5 to 10 years. Those delayed attacks can strike untreated people with longer-lasting, severe pain in several joints, sometimes all at once and sometimes in one joint after another.

• Eventually, chronic gaur sets in. This final, continuous stage shows up in persistently painful joints, with large urate deposits in the cartilage, membranes between the bones, tendons, and soft tissue. Deposits form primarily in arms and legs and, rarely, in organs, such as the kidneys and heart lining.

The skin over the deposits may develop sores and release a chalky, white material or pus. Chronic inflammation and urate deposition progress to further restrict movement and harm the person’s general health, possibly including formation of kidney stones.

How is it diagnosed?

The doctor can find evidence of gout in fluid taken from an inflamed joint or a deposit and by checking the level of uric acid in the blood. In chronic gout, X-rays show damage to the cartilage and bones.

How is it Treated?

The doctor first tries to stop the pain and prevent complications by suggesting bed rest and protection for the painful joints. Hot or cold packs and pain relievers may help with mild attacks. For more severe attacks and chronic gour, treatment may include the following:

• drugs to reduce inflammation, including Colsalide, Butazolidin, and Indocin, and injections of corticosteroids or corticotropin

• slower-acting drugs to reduce the uric acid level in the blood, including Zyloprim, Colsalide, Benemid, and Anturane

• diet changes, primarily to avoid alcohol and some rich foods; obese people should try to lose weight because the extra weight puts more stress on painful joints.

• surgery to improve joint function or correct deformities. Deposits must be opened and drained if they become infected or ulcerated. Deposits can also be cut out to prevent ulceration, improve the joint’s appearance, or make it easier to wear shoes or gloves.

What is this Condition?

In hammer toe, the big toe becomes crooked at the joint where it lines up with the other toes. The end of the bone is enlarged and a bunion (inflamed, thickened toe joint tissues) forms where it rubs the shoes. Hammer toe can cause a callus on the sole of the foot and make walking painful.

What Causes it?

Hammer toe may be inherited, but it more often develops in people with degenerative arthritis or in those who place prolonged pressure on the foot, especially from narrow-toed high-heels. That’s why hammer toe is more common in women. The condition also can develop in children who rapidly outgrow shoes and socks.

In congenital hammer toe, abnormal alignment of the bones (increased space between joints) causes bunion formation. In acquired hammer toe, the bone alignment is normal before the disorder occurs.

What are its Symptoms?

Hammer toe usually begins as a tender bunion covered by deformed, hard skin and a bump that feels distended with fluid. The first indication of hammer toe may be pain over the bunion from shoe pressure. The pain could come from injury-caused arthritis, bursitis, or abnormal stresses on the foot because hammer toe changes the way a person walks. In an advanced stage, the foot may appear flat and spread out, with severely curled toes and a small bunion on the fifth toe.

How is it Diagnosed?

A red, tender bunion makes hammer toe obvious. X-rays confirm the diagnosis by showing a crookedness of the big toe.

How is it Treated?

Depending on the severity, hammer toe may require the following treatment:

• In children (and some adults), repeated foot manipulation and splinting may relieve pain and correct hammer toe.

• If the disease progresses to severe deformity with disabling pain, the person may need surgery to remove the bunion. After surgery, the toe is immobilized in its corrected position with either a soft dressing or a short cast.

• After surgery, the person may need crutches for 4 to 6 weeks, or may simply learn to walk on his or her heels for a few days. The individual may be taught about physical therapy, such as applying warm compresses and soaks and doing exercises, as well as using drugs to relieve pain and stiffness.

What can a Person with Hammer toe do?

In the very early stages of acquired hammer toe, good foot care and proper shoes may eliminate the need for further treatment.

A person can use felt pads to protect the bunion, foam pads or other devices to separate the first and second toes at night, and a supportive pad and exercises to strengthen the arch. Early treatment is vital if other foot problems caused by rheumatoid arthritis or diabetes are present.