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Veg,

Its sounds like you have a similar situation to mine (read my post “lingering symptoms)…I had 5+ weeks with lingering paiin (although initially I had a severe attack for a couple days).  I finally got a Rx of Colchicine last week and that seemed to really help.  My pain is now down from a 6 to about a 2…and hopefully fading in the near future.  Like Zip said in my thread.  “If Colchicine doesn't work, then there's a good chance it AINT gout!”

Post edited 8:05 pm – August 19, 2009 by vegetarianGuy

cjeezy said:

Veg,

Its sounds like you have a similar situation to mine (read my post “lingering symptoms)…I had 5+ weeks with lingering paiin (although initially I had a severe attack for a couple days).  I finally got a Rx of Colchicine last week and that seemed to really help.  My pain is now down from a 6 to about a 2…and hopefully fading in the near future.  Like Zip said in my thread.  “If Colchicine doesn't work, then there's a good chance it AINT gout!”

Yeah but I never had a severe attack Do you mean that even touching it  or rubbing it gently would hurt? I have always been able to rub and pinch without serious pain. If I press hard at some points then it is painful like a stabbing pain. Rest of the time I have a hot burning type of pain deep inside the joint. With some random pin and needles sensation thrown in. Actually it is hard to describe what I feel

I really hope things will be clearer next week as I can't take this mental torture anymore!

cjeezy said:

I don't think everyone gets a severe attack all the time…but I'm no Dr.  At this point I would try Colchicine.  What do you have to lose? 

I would try it if I could . Is it not a prescription only drug? I am seeing hospital doc in few days so I will have to wait.

Veg guy,

Your uric acid is TERRIBLE…so that says gout.

But it's not the typical affected joint which is the SECOND joint from the end of the big toe, the bunion joint that is attacked…so that says NOT gout.

To my eye, it looks most like you got a splinter or someting into the juncture of the toenail and the outer edge of your toe. It is indeed infected but it doesn't look gouty to me. Admittedly it's a hard call from the picture.

In any case you must do something about that hyperuricemia. Since you are a vegetarian, and thus not eating too many purines, if I were you I would have a pee test for 24 hours to determine how much uric acid you excrete. If very little then probenecid might be a good drug for you.

(Okay, who screwed up the HTML coding to make this thread two monitors wide? Perhaps the big pictures…a natural mistake.)

This doesn't quite ring the gout bell for me, VG!

With all that walking when it was worse -that would surely trigger an attack at 10+ SUA .

One thought, If it IS gout- then it may be that your immune system is not reacting as it should.

This is a part blessing- have you ever taken Immune boosting supplements like Vit C, E or Zinc?

If so, has it affected your foot pain? It does take time for the supplements to get your immune reaction levels up though and as you keep fit ,just a long shot.

Also, if your colds last a long time -or you get re-current infections?

THe arrow on the linked picture is much closer to the usual joint.

And you MUST treat the hyperuricemia.

So whether it's gout or not causing that constant pain your course will be the same, allopurinol

or probenecid (I'm guessing the latter) to get you a low normal uric acid. If it IS gout then your foot pain will be cured.

Have that pee test to see how much urate you excrete in a day.

Post edited 2:56 pm – December 2, 2009 by vegetarianGuy

cjeezy said:

Hi Veg,

Any updates on your status/treatment?

Sorry for not replying earlier. I had typed a long post but I lost it thanks to hitting the back button. Then I had PC probems etc etc.

Ok so I finally went to the Rheumatologist at the hospital for my appointment. I was well prepared with timetable of pain, blood readings, X-rays, my lifestyle and possible treatment.  Doc was impressed with my thoroughness and smiled. He checked my feet properly. Pushing the bottom of my toe with his palm was a sure way of recreating the pain. Anyway he said that he is very sure that I don't have Gout. He straight away remarked that my feet are bit flat. He also noticed that the gap between my toe and the second finger is large (scroll up to see photos). As a result  proportionally he thinks that my feet are bit wide towards the front. On the right foot he found some hardened skin underneath which he said supports his theory. Although it was on the non problem feet. Just for the record left toe main problem foot. Right toe semi problem foot.

He said that there is no way I have Gout. Gout attacks don't last for months on end like I have specially first Gout attack. Chronic Gout later on could give constant pain. In my case he thinks it's not Gout so question of Chronic gout does not even arise. He thinks it's mechanical problem and a shoe insert would take care after 2-3 months of use.

He then called the head Rheumatologist who checked me and concluded the same thing. I asked him about my high blood uric acid reading. And the head Rhumetologist said that if I had gout then those readings would be cause for worry. As what I have is  in no way gout so those readings are not relevant.  He said relation between blood uric acid and Gout is very complicated and not straightforward as some would liek to make it out. In my case it does not matter anyway as what I have is not a Gout attack.

Long story short I then went to have my feet measured and scanned to get a shoe insert made. I have been wearing an insert in my shoe for last 2+ months but I have not noticed any consistent change. First week felt bit better but afterwards it was same as always. It's coming to 9-10  months since I first noticed the pain and since then I have constant mid level pain I will be making another appointment and going back to the hospital to say that the foot insert did not solve the problem. He did say wear it for 3months. Thing is I am not noticing any real difference after 2 months so I doubt it will change suddenly.

So to recap-

– In total 3 Rheutatologists have seen my feet. The two at the hospital and the one I went to see privately.
– All three say that my feet are wide at the front  and slightly flat.
– All three say I don't have Gout irrespective of my above normal uric blood acid readings
– All three refused to have my joint fluid taken because they say there is no Gout like swelling to extract anything from. “You don't have gout”.
– I have been eating tons of Beans, Mushrooms, peas and it makes no difference to my toe pain. The sucker is there all the time constantly at 5 out of 10 pain level.
– I go gym regularly and that does not increase or decrease my pain either.
– Unlike typical Gout sufferers pain has never been so great that I could not squeeze my toe (all of last 9 months)
– No extra pain in the morning or night like some Gout people mention.

I am completely LOST and depressed about the whole issue!!!!!! I try to blank it out but having constant mid level burning type of pain sensation for last 9 months  24/7  on both toes is hard to ignore At this moment I have no clue what I have. I thought the shoe insert would be the answer but so far it has failed.

GP the thing is that I might have slight mechanical issues but I am convinced that it is NOT what is cauing me this pain. Mechanical problem in my opinion should create more pain when I do mechanically intensive things like running in the gym or walking a lot.I just don't see any clear relation between mechanical movement and increase or decrease in pain.

> I suggest a foot specialist rather than back to the rheumatologist.

I will go back to him once more just to give him a chance. All the heavy hitting medical equipment is in the hospital anyway. By the way what do you mean by a foot specialist? Are they more specialized than rheumatologists?

And whilst you are in Spain, from Nucleosides, nucleotides & nucleic acids:

Asymptomatic hyperuricemia: impact of ultrasonography.

Puig JG, de Miguel E, Castillo MC, Rocha AL, Martínez MA, Torres RJ.

Divisions of Internal Medicine, La Paz University Hospital, Madrid, Spain. jgarciapuig@terre.es

Thirty-five patients (23 males) with asymptomatic hyperuricemia for at least two years underwent two-dimensional ultrasonography of knees and ankles. Urate deposits (tophi) in tendons, synovium, and other soft tissues were detected in 12 patients (34%). Increased vascularity (inflammation) was evident in 8 of these patients (23%). Tophi were more frequently found in knees than in ankles and were especially prevalent in the distal patellar tendon. The presence of tophi was unrelated to the known duration of hyperuricemia (mean, 5 years). Ultrasonography allows detection of tophi and inflammation in a third and in a fourth, respectively, of asymptomatic hyperuricemic patients.

PMID: 18600510

Post edited 11:45 am – December 10, 2009 by vegetarianGuy

gigi said:

to vegetarian guy:  you say you were taking Berocca supplement which contained B vitamins and niacin among other things.  i also was taking a supplement that contained B vitamins and niacin among other things.  Isagenix.  i had been on this for about a month and a half.  could there be a correlation?  i also had started a pretty vigorous exercise regimen of pilates 2 x a week, yoga 3 x a week and running 3 x a week.

Well I do take them but not very regularly. There have been long periods when I did not take them and it did not change my toe pain level.  My B6 and B12 levels are in the normal range but on the lower level side hence I take Berocca or cheaper multi vitamins sometimes. I have been reading about side effects of Berocca and I don't have other mentioned side effects. Well apart from joint pain (toes only). I don't have pain in any other joints though. 

I called the hospital  and the next available appointment was  in early January so I took it.  Wasted money on these shoe inserts and they do jack for me! Maybe they help slightly.

I have been wearing canvas shoes as their soul is thin and very flexible.  I can get on with daily activity but if I wear my older Addidas shoes whose soul is thicker then I have problems walking as pain on the toes increases noticeably. It's amazing how shoes I could wear all the time before are almost unusable now.