Hi Dr. Blake,
I found your blog while doing some research for my husband, and I hope you don’t mind if I shamelessly solicit your opinion on the below situation J.
My husband had sesamoidectomy completed on both big toes well over 15 years ago and he continues to have very debilitating flare ups. He is 48, very active, and has a busy work travel schedule and an active job that requires him to be on his feet a large majority of the time. He frequently has flare ups where either his big toe, middle toe, or all toes will become discolored, very inflamed, and extremely painful. During these episodes he takes Naproxen and wears a boot, but he is still in pain even after taking the Naproxen. These events will last anywhere from 2-3 days to over a week, and although he probably wouldn’t admit it, cause him some degree of depression. He has been to his doctor and was recently diagnosed with gout, BUT, his uric acid levels are normal, so I don’t buy it J. I am trying to encourage him to seek out additional opinions on his condition and to get physical therapy of some kind, but I frankly think he is scared. He is very resistant to my suggestions to the point of stubbornness. I can’t quite understand it.
I am curious what information I might be able to share with him around physical therapies and exercises for his condition. Everything I have read around joint issues, such as arthritis, is to stay active and keep joints mobile. What are your thoughts?
Any feedback at all would be GREATLY appreciated.
Dr. Blake's comment: Thank you so very much for your email. This situation could be a lot of things, and I agree gout flare-ups quite commonly present like this. His gout test, uric acid in the blood, can just run high normal and he is prone. It would be great if you could find his uric acid level and email to me. I would need his level, and the range of the lab that they consider normal. Does he have any family history of gout? Do you think he has rich foods a lot? Or is he chronically dehydrated?
What he is experiencing is not normal, and getting to the diagnosis is essential? Any other blood work abnormal? If he has one side that is worse, and he feels the trigger for the pain is the big toe joint, then he should get a CT Scan to look for pieces of the sesamoid that were left behind. That could be causing the problem. A Plantar Axial view of the feet shows the sesamoid area, and any doctor can order that. I hope this helps some. Rich
Dr. Blake's comment: Thank you so very much for your email. This situation could be a lot of things, and I agree gout flare-ups quite commonly present like this. His gout test, uric acid in the blood, can just run high normal and he is prone. It would be great if you could find his uric acid level and email to me. I would need his level, and the range of the lab that they consider normal. Does he have any family history of gout? Do you think he has rich foods a lot? Or is he chronically dehydrated?
What he is experiencing is not normal, and getting to the diagnosis is essential? Any other blood work abnormal? If he has one side that is worse, and he feels the trigger for the pain is the big toe joint, then he should get a CT Scan to look for pieces of the sesamoid that were left behind. That could be causing the problem. A Plantar Axial view of the feet shows the sesamoid area, and any doctor can order that. I hope this helps some. Rich
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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.