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Gout is a type of inflammatory arthritis, often termed ‘the disease of kings’, caused by the deposition of uric acid (monosodium urate) crystals in tissues and typically the joint fluid. This occurs as a result of excessive production of uric acid by the body, or under-excretion of uric acid by the renal system.

Gout is characterised by four clinical phases: 

1. Phase I – involves the deposition of uric acid with no symptoms

2. Phase II – (further uric acid deposition) involves intermittent acute attacks of pain and inflammation which resolves spontaneously over a period of 7 – 10 days.

3. Phase III – The stage between acute gout attacks and persistent crystal accumulation.

4. Phase IV – If the excessive crystal deposits are not controlled, individuals can transition into phase IV of gout, which is characterised by chronic crystallisation involving numerous joint attacks and the deposition of crystals in joints as well as in soft tissues.

Risk factors:

Men are more likely to develop gout and a family history of gout also increases the risk of developing the disease.

Risk factors for gout includes:

  • Some drugs: e.g thiazide diuretics, cyclosporine, low-dose aspirin
  • Diet that mainly consist of meat, seafood and refined sugars/drinks or alcohol.
  • Other factors that are associated with gout include insulin resistance, metabolic syndrome, obesity, renal insufficiency, hypertension, organ transplantation and congestive heart failure.

Recurrent attacks or flares can also be induced by the use of recent diuretics, alcohol intake, surgery or trauma and recent hospitalisation; initial use of uric acid lowering drugs can also trigger gout attacks in the early periods, however reduce the risk of attacks in the long term.

Signs and Symptoms:

Clinical features of gout include spontaneous onset of intense pain, swelling and redness that most commonly affects the big toe joint (known as podagra). It can also affect other joints of the foot, ankle, mid-tarsal, wrist and knee.  Other problems that can cause similar symptoms include pseudogout, psoriatic arthritis and septic arthrtis.


The standard for the diagnosis of gout still remains removal of the joint fluid and evaluation to check for monosodium urate crystals under a microscope. As gout and septic arthritis can co-exist it is also essential to analyse the joint fluid for bacteria through culture. Radiographic imaging of the joints can show the changes due to a chronic history of gout. Sometimes, evidence of crystals in the joint may be seen, but not always. Recently, ultrasound, CT and MRI are also emerging techniques for the diagnosis of gout.


Treatment of gout can involve drug therapy as well as support and rehabilitation measures. Pharmacological management aims to treat acute gout attacks and also helps to maintain an appropriate level of uric acid in the blood in order to prevent recurrence. The British rheumatology guidelines prefer the use of NSAIDs at a high dosage (given no contraindications to its use) with a treatment period of 1-2 weeks. Therapy starts with high doses of anti-inflammatory medications for the first few days with a decrease in the dosage as the symptomatology subsides. For acute attacks of gout, another drug called colchicine is also used in addition to anti-inflammatory medicine.

Long-term management for gout consists of managing the urate levels and maintaining the concentration below a certain level. However, urate-lowering drug therapy is only indicated in patients who have experienced multiple gout attacks or chronic joint pathology and extensive crystal deposition.

Chronic gout can be painful and significantly reduce the mobility in the joint due to the crystal deposits, and the inflammation and damage caused by this. Orthotic therapy is often beneficial in order to increase the range of motion of particular joints and protect the foot from further deformity that can be caused by chronic gout.



Why am I getting pain under my big toe?

Pain under the ball of your foot, especially under the big toe joint could be indicative of sesamoiditis. Sesamoids are two small bones that are located under your big toe and because of this position they are often under excessive loads. Due to this, these bones can become irritated or inflamed and, in some cases, they can fracture.  


Sesamoiditis often has a gradual onset, whereas fractures of the sesamoid are instant. The main causes of sesamoiditis include: increase in activity levels, constantly wearing high heeled shoes, repetitive walking uphill, reduced fat pad under the sole of your foot and having a high arched foot type. There may be other causes, related to the way you walk.


  •       Pain under the ball of your foot, specifically under the base of the big toe.
  •       Swelling and bruising around this area.
  •       Occasional pain when bending or straightening the big toe.
  •       Pain worse in high-heeled shoes.


Treatment for sesamoiditis includes: resting and icing the area, taking anti-inflammatory medications, wearing shoes with a low heel and softer sole, deflective padding, immobilization taping, steroid injections and custom-made orthotics. For fractures of the sesamoid: you may also need to immobilize your foot in a special boot during the initial phase of the treatment. If conservative treatment measures fail, then your Podiatrist can refer you for a surgical opinion. In either case, a proper diagnosis and treatment is important, so come in and see your podiatrist!

Five Common Foot Problems and What You Can Do About Them

Five Common Foot Problems and What You Can Do About Them

Photo credit: HeelThatPain.com

Plantar fasciitis1. Plantar fasciitis

Plantar fasciitis or heel spurs is a common foot problem, which presents as pain under the heel that is worse after periods of inactivity. The plantar fascia is a band of tissue that starts at the bottom of the heel and finishes just behind the base of the toes. It used to be thought that plantar fasciitis was an inflammatory condition, but recent research has shown that it is not due to inflammation, but rather is caused micro-tears in the plantar fascia that leads to scar tissue deposits and thickening of the plantar fascia. People with certain foot types (e.g. flat feet) are predisposed to getting this condition, but it has a number of causes.

What your Podiatrist can do?

Your Podiatrist can give you advice regarding the cause of this condition, and use techniques to promote healing and reduce the load on the plantar fascia. This can be in the form of footwear advice, stretching and strengthening programs, taping, low-level laser therapy, ultrasound therapy, compression socks and long-term support with custom made orthotics.

What you can do at home?

You can use an ice and/or heat pack on the area in order to reduce some of the pain but promote healing at the same time. You can also use a tennis or golf ball to massage the area. Make sure that you wear a supportive shoe that has a little bit of heel height to help offload the plantar fascia.

bunions2. Bunions

Bunions are bony protuberances that form as a result of angular changes to your big toe joint. They can be formed due a number of factors including but not limited to: congenital deformities, arthritis, footwear, trauma and genetics. They can be unsightly, painful and make it difficult to find shoes that fit. In the elderly, bunions have been shown to increase the risk of falls.

What your Podiatrist can do?

Your Podiatrist will discuss treatment options for your bunion. Conservative treatment options can be in the form of wedges, cushioning and padding, and perhaps referral for specialised footwear and custom orthotics. Bunions can be treated successfully with surgery.

What you can do at home?

A good start is to change your footwear to something with a wider toe-box, which can relieve pressure and discomfort.

Calluses and corns3. Calluses and corns

Corns and calluses on your feet occur as a result of excessive pressure or shearing stress. They can be very painful. They can be caused by wearing ill-fitting footwear, having bony deformities on your feet, and sometimes due to the way you function when walking.

What your Podiatrist can do?

Your Podiatrist can remove the callus or corn using a scalpel blade, which provides prompt relief from discomfort. They can also advise you about techniques to offload the area to reduce the recurrence of corns or calluses. As calluses and corns develop due to excessive pressure, regular visits to the Podiatrist may be necessary to maintain your feet. If they are due to bony deformities, then fixing these surgically can prevent recurrence of calluses and corns

What you can do at home?

You can increase the length of time it takes for the callus to come back by using a pumice stone to file the area. Moreover, for corns you can use padding, toe-spacers or gel protectors to offload the area.

fungal nail infections4. Fungal nail infections

About 10% of adults (and more in the elderly) develop fungal nail infections, which are caused by a common type of fungus. Fungal infection of the nail can cause your nail to become thickened, crumbly and discolored. A fungal infection of the nails is always accompanied by a fungal infection (or colonisation) of the skin.

What your Podiatrist can do?

Your Podiatrist will discuss the condition with you and can give you advice on evidence-based treatment options including – topical medications, oral medications and laser therapy. They can also talk to you regarding hygiene and other techniques to help prevent the recurrence of fungal nail infections.

What you can do at home?

You can apply tea tree oil or tea tree solutions to your fungal nails, as tea-tree oil as antibacterial and mild anti-fungal properties. You should wash your socks in hot water (preferably 60 degrees centigrade or above) in order to kill any fungal spores. You should keep your feet dry and clean to help prevent fungal infections of the skin.

Ingrown Toenails5. Ingrown Toenails

Ingrown toenails occur when the toenail turns inwards and grows into the skin around the toe, which can also become inflamed and infected. They may occur after you have been picking your nails, but many people are susceptible to them, and can get recurrent ingrown toenails.

What your Podiatrist can do?

Your Podiatrist can remove the painful nail spicule, in a sterile manner, to relieve the pressure and thus the pain. In more severe cases, they can also surgically remove the sides of the nail in clinic surgery under local anesthesia to provide lasting relief from your ingrown toenail. The nail still looks normal after this, as only the part of the nail that goes down the side is removed.

What you can do at home?

Maintain good foot hygiene, don’t pick at your nails, and don’t clip your toenails too far down the sides of the nail. Leave a little border of the nail showing after you have clipped them.