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Sunday, March 6, 2011

Swollen Big Toe: Gout or Infection

http://www.drblakeshealingsole.com/2010/09/gout-treat-symptoms-immediately.html
Robert presented with this swollen big toe 2 days ago. It came on suddenly, without incident, and initially was only in the big toe joint. The foot was red around the ball of the foot with the redness over the last 3 weeks spreading to his ankle. His pain is now throughout the big toe, but does not involve the toe nail itself. These presentations are either infection or gout, and there was no reason he should have an infection (no cuts in the skin, etc). His primary care doctor has placed him on 2 courses (10 days each) of antibiotics without relief. Unfortunately, if you have a gout attack, the uric acid crystals leave your blood stream and attack the involved joint, so the blood levels are temporarily within normal limits (but they still are high normal). I decided to place Robert in a post op shoe since he was walking around in his sock (can not take any pressure), and gave him 2 low dose cortisone shots into the 2 involved joints. He called me the next day saying that he was so much better, and actually slept for the first time all night in 2 weeks. Of course, you do not want to give cortisone into a joint that may be infected, but his history and exam did not point to anything but gout. I will check him next week. I also recommended icing 10 minutes 3 to 5 times a day to cool down the joint. I will get blood work in 3 weeks to see what his blood levels of uric acid are then.

8 comments:

  1. My husband has a toe that looks like this, some scaling, no pain and he just came home 3 days ago from 5 days in the hospital on antibiotics to counteract his negative reaction to being on IV antibiotics for 10 days. Before this he was on antibiotics and a medrol pack for a full course. They now have him on antibiotics and probiotics and his toe is still red, swollen and warmer than his other foot. Please - let me know if you have any idea what this could be. He has been to several doctors including infectious disease, rheumetologist, pediatrist and his regular doctor. I have started using tea tree oil on it in the last day. Thank you for any information or recommendations you can provide. kayhlas@gmail.com

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    1. It could be cellulitis look up the symptoms in had it when I was pregnant with my son they thought it was a blood clot the skin will be warmer pain and redness hope it helps

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  2. Hi. MY NAME IS NIGEL, I'M 49 YEARS OLD AND I PRESENT VERY SIMILAR SYMPTOMS TO ROBERT. INFLAMED RED TOE, SWELLING AND REDNESS OF THE ENTIRE, AND RESTRICTED TO THE TOE. MY TOENAIL ISN'T SORE EITHER, YET I DON'T SUFFER EXTREME DISCOMFORT WITH ANY OTHER KIND OF SHOE ON. I FIRST ENCOUNTERED IT ABOUT 2 MONTHS AGO, IT LASTS FOR ABOUT 3 TO 4 DAYS THEN IS GONE. WHAT I HAVE NOTICED IS THAT AFTER WEARING A SPECIFIC PAIR OF TACKIES,THE PROBLEM RAISES IT'S HEAD. AFTER A FEW DAYS OF WEARING NORMAL SHOES AND SLIPPERS AT NIGHT, THE PROBLEM DISAPPEARS. I'VE TAKEN VOLTAREN TABLETS AND THIS APPEARS TO HELP. COULD THIS BE GOUT? I'VE RECENTLY UNDERGONE A CONCURRENT HEALTH ASSESSMENT WHERE BLOOD SAMPLES WERE TAKEN. WOULD THESE TESTS REVEAL ABNORMAL LEVELS OF URIC ACID IN THE BLOOD? OR SHOULD I ASK FOR SPECIFIC BLOOD TESTS?

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  3. Hi, thankyou for an exceptionally informative blog post, I wouldn't ordinarily attach posts but enjoyed your post thus thought I'd personally say thanks for your insight --
    Isabella
    My homepage ; heel spur

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  4. I had uni-compartmental surgery on left knee 8 days ago. I am now suffering from pain in left foot, sesamoid area of big toe. Taking anti-biotics and pain meds and PT. Could this be a side affect from surgery? Infection or even a fracture? I don't see my Dr again for another 12 days, but don't know if I should wait and see if pain goes away or go in on urgent care. Please advise.

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    Replies
    1. Perhaps you were limping alot prior to surgery on the knee and injured the ball of your left foot. You will also swell in your foot and ankle after knee surgery on the same side increasing the possibility of soreness. Fracture is possible, infection unlikely, so a visit to the ER without obvious incident of injury probably will not help. Of course, alot of ifs, ands, and buts. Email me directly if you have more information 3 days since your post. Dr Rich Blake

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  5. All cherries have been reported to be a natural gout cure. The amount of cherries to eat a day is between ten cherries and up to one half pound.
    Gout Foot Pain Winston Salem NC

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  6. I WAS TOLD MY AUTISTIC SON HAD GOUT TWICE..BUT DID NOT HAVE ANY URIC ACID LEVEL..WELL IT TURNED OUT HE HAD A RAGING INFECTION THAT SPREAD TO HIS BONE..WHICH LED TO AMPUTATION OF THAT TOE..THE DRS DIAGNOSIS WAS WE DON'T KNOW WHAT TYPE OF INFECTION CAUSED THIS..HIS GOUT COULD HAVE GOTTEN INFECTED..COULD ANYONE PROVIDE AN ANSWER ARE SIMILAR SYMPTOMS.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.

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