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Photo courtesy: Consumer Reports

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.

Köhler’s Disease

Köhler’s Disease

Photo credit: Fixmyfeet.co.za

Köhler’s disease is a condition that impacts a bone on the inner arch of the foot. This bone is called the navicular.

This relatively rare disorder of the foot typically affects males more than females and occurs between the ages of 2 and 10 years of age with a peak occurs during the ages of 3 to 7 years.

It is not fully understood why this condition occurs. Some researchers suggest that it is caused by excessive strain on the navicular bone, while others believe that it is caused by injury/trauma to the area. As a result of this, the blood supply to the bone get compromised as the child is growing. This leads to loss of blood flow (ischaemia) to navicular resulting in progressive degeneration of the bone. If not treated promptly, the bone can become permanently deformed.

The signs and symptoms of Köhler’s disease can differ, but they generally include:

  • Redness around the inside of the foot, near your arch
  • A swollen foot
  • Tenderness/pain along the inside of the arch
  • Pain worse if putting pressure on the affected foot

This is an uncommon condition that warrants proper diagnosis, care and management. Generally, it does resolve on its own. It is important not to aggravate the condition as it can lead to complications later on in life. If the condition is very severe (as determined by X-ray/CT scans) then a fibreglass cast or moon boot may be required in addition to other treatment options. See our Podiatrists here for more information regarding this condition.

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Intoed Gait

Intoed Gait



Do you feel like one of your leg points inwards when you walk, and you often find yourself tripping over? Or do you observe that your child’s feet tends to turn inwards (or perhaps they are clumsy when playing with friends)? This condition is known as in-toeing. In-toeing commonly occurs due to four main factors that stem from either your hip, legs, feet or muscles:

1.    Thighs are turned inwards (femoral anteversion)
2.    Leg is turned inwards (internal tibial torsion)
3.    The front part of the foot turns towards the midline of the body (metatarsus adductus)
4.    Tight muscles in the legs

Most children with intoed gait will outgrow it, so in most cases it is something so keep and eye on and manage, but does not usually lead to long term problems.

Your Podiatrist will be able to assist you in determining where the in-toeing is stemming from and will be able to provide you with advice regarding non-surgical management of the condition (it is very rare to require surgical treatment).

At home there is a few things you can do. If you are worried that your child maybe in-toeing, get them to perform a squat. Firstly, avoid sitting in a W-position but instead start sitting cross-legged to stretch out your hips. We also encourage that you take up activities that position your hips, leg and foot in an outwards position, including activities such as horse riding, ballet and swimming (breast stroke preferred). See your podiatrist today for assessment and further advice. At the Perth Foot & Ankle Clinic we can use our Bodytech gait analysis machine to assess intoed gait and monitor over time.

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Common Foot Problems 12
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Wart is this on my foot? – Verruca Pedis

Wart is this on my foot? – Verruca Pedis

foot wart

Plantar warts, medically termed verruca pedis, are painful, solid and thickened lesions that are caused by the Human Papilloma Virus (HPV). If the wart is located on the bottom of the foot, warts can be extremely painful and it can sometimes significantly affect a person’s quality of life.

Warts can be contracted or transmitted when an individual comes into direct contact with the virus when the outer layer of the skin becomes damaged. Sometimes, these warts can resemble calluses or corns. This is because, its location on the plantar aspect of the foot subjects the lesion to increased pressure and forces. Hence, it is necessary to seek professional assistance in order to determine the correct diagnosis and thus the correct treatment option for the lesion. Typically, warts can resolve on their own, it usually takes from a few months to 2 years to completely disappear. Often the pain can be unbearable for some (because of its location on the sole of the foot), in which case other treatment options may be required.

Treatment for plantar warts:

  • If the wart isn’t bothering you, you can simply wait for resolution
  • Topical acids for plantar warts
  • Cryotherapy for plantar warts (this can be slightly painful)
  • Laser plantar wart removal
  • Wart surgery/curettage

Advice we give regarding warts:

  • Make sure you don’t pick at or scratch your warts
  • Cover the wart with medical tape to prevent spreading
  • Avoid sharing articles of clothing that have come into contact with the lesion
  • You can use a small corn pad (which fits the wart’s diameter) to offload the area.

Do I need surgery for my wart?

Wart surgery (curettage) is required if the wart is persistent, has been present for several years, is not responding to other treatment, is extremely painful or you require quick plantar wart removal. At the Perth Foot and Ankle Clinic we can perform the surgery here at our clinic in our operating room. The surgery typically involves numbing the area with local anaesthetic, after which one of our Podiatrists will remove the wart in a sterile manner; we also use a small amount of chemical to destroy any remaining wart tissue to reduce the risk of recurrence. Speak to one of Podiatrists if you require further information.



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!