Been to Dr about my foot injury and suspected Metatarsalgia to 4th Metatarasl
Diagnosis is Gout. Injury to big toe joint in early October is almost certainly gout as well. Trigger in both cases is related to dehydration (and I suspect beer drinking while dehydrated). I did a 1 hour zwift challenge on Friday at our end of year celebration, unfortunately there was no fan, and I was sweating buckets. This was followed by Beers and pizza. A long ride on Saturday, and I was still dehydrated (some beer in evening), then a hike on Sunday, with more beer in the evening.
The onset was similar in both cases. No discomfort while exercising, then pain in joint at night a coupel of days later. This time there was no running that I could blame for causing an injury
My Grandfather, also suffered from Gout, so probably runs in the family
I eat very little meat, but do enjoy a beer or 2. My diet also has a lot of fructose, from natural fruit, but also from gels
I suspected that I had an episode of Gout a couple of years ago. Looks like I need to be even more careful about what I eat and drink
OUCH! My Dad had gout at Christmas New Year 99/2000 and it looks like absolute agony.
He didn’t seem to find much relief from changes in diet and being conscious of his levels of hydration, but has been on Allopurinol since and hasn’t had any issues. Being on medication indefinitely might not be that appealing, but as an N=1 it’s worked well for him.
Sorry to hear, I have it in my family too and had an episode of it a few years ago.
I am now super careful about diet, which seems to keep it under control, dehydration is also a trigger I am very aware of.
The trigger for me seemed to be Soya - that was the only thing that had changed significantly in the run up, I now avoid it like the plague and so-far I have not had a recurrence.
I keep a box of Anti inflammatories in the drawer just in case.
Thanks, it is uncomfortable, but from other people’s experience it could be much, much worse. In October it was uncomfortable for a few days. Wearing tight shoes was very unpleasant. Its a different toe joint this time, and since it is on the latteral side of my foot it is harder to walk normally: when it was the big toe, it was pretty easy to walk on the outside of my foot, but walking on the insider of my foot is trickier.
@The_Iain I will try to avoid medication if I can, I think that being aware of triggers is important
@LordFlasheart I hadn’t heard of Soya, its interesting that what triggers it is not the same for everyone
Insist that he gives you Naproxen or some other anti inflammatory. There is another cure out there called colchicine, which I have on good authority is useless.
I’ve had a few episodes of gout over the years - the first time is always the worst as mine was. change of diet and upping the exercise helps reduce the problems
I like to think my diet is pretty good. I only eat a tiny amount of meat, I have even reduced my cheese substantially. I am not a heavy drinker, but often drink a couple of beers in the evening, will be sad to give up beer. I am rather partial to chocolate, and usually have a good stash, buut keeping off it for now
I have booked another GP appointment today. I want her to check whether it is an infection in the joint as symtoms are very similar to gout. I can feel that the joint under my 4th toe is very swollen. Overnight, the pain is localised to this joint, but during the day pain is spread over a much wider area
given your exercise levels and diet I’d be most surprised if it is gout - and it’s usually the big toe that is affected first, not other toe joints. my 1st episode was when I was in my 30s but at the time I was eating a fair bit of red meat and drinking lots of beer and red wine so it wasn’t surprising I succumbed. I never had drugs, but just changed what I ate and drank (still do beer and red wine!) and it went. Has come back a couple of times but nowhere near as bad and has always been temporary.
Never heard of gout in 4th toe, can affect any joint but most commonly 1st toe and knees. The dehydration/beer trigger seems semi convincing for gout though, and combined with family history. Urate blood levels can help, most useful to do them when not in a flare as can be normal in flares because the urate is crystallised in the joint. Best way to know is to get an aspirate and send to lab to see the crystals of gout/pseudogout. Aspirate would also rule out infection, but again that is even less common in a 4th toe MCPJ.
Everyone straightaway looks to diet/alcohol etc as cause of gout, but vast vast majority is due to low renal excretion of purines rather than excess intake. Obviously decreasing intake/avoiding dehydration will help in someone predisposed to it, but that sometimes it’s just one of those things rather than a clear dietary fault.
Soya as a trigger sounds like a red herring, literature suggests it should be protective, but we all have our n=1 quirks.
Expect blood test to come back in next 2 days. MRI scan booked for Thursday to check for stress fracture. Dr 90% sure it is Gout… she said told me that gout is still common even when DIet is good and not much alchohol
From what I have read, 4th Metatarsal would not be a common stress fracture location. Also Dr said that stress fracture pain comes on gradually, Gout comes on suddenly
I attributed swelling in first toe joint caused by trail running in the summer, but feels very similar to this episode… came on suddenly in the night after a day trail running.
I think that because hiking and trail running are at lower intensity I do not hydrate as well as I do when running
Woke up this morning, and as if by magic, pain almost completely disappeared, yesterday I could hardly walk, and riding a bike was impossible. This pretty much confirms doctor’s diagnosis of gout. I think that I was pretty lucky, with a flare up lasting just 2 days.
This is clearly something I need to watch carefully
On the site of pain. I had a patient a few years ago, come with foot pain. He had been running a year or so but the foot pain didn’t match up with running but would randomly come and go. He had been to GP and physio but with no diagnosis or change in symptoms. He had mentioned a change in diet and on further questioning he had increased his protein and reduced carbs to lose fat. It was gout but on the naviculocuneiform joint, medially. Its location was why it was missed. A change in diet for him fully resolved it.
