Gout and Your Feet

As we are finally past the holiday season, I wanted to post an article about gout. This painful condition is always more frequent during the winter season of eating. What is gout, specifically? Gout is a disorder that results from the build-up of uric acid in the tissues or a joint -- most often the joint of the big toe. An attack of gout can be miserable, marked by the following symptoms: • Intense pain that comes on suddenly -- often in the middle of the night or upon arising. • Redness, swelling, and warmth over the joint -- all of which are signs of inflammation. What Causes Gout? Gout attacks are caused by deposits of crystallized uric acid in the joint. Uric acid is present in the blood and eliminated in the urine, but in people who have gout, uric acid accumulates and crystallizes in the joints. Uric acid is the result of the breakdown of purines, chemicals that are found naturally in our bodies and in food. Some people develop gout because their kidneys have difficulty eliminating normal amounts of uric acid, while others produce too much uric acid. Gout occurs most commonly in the big toe because uric acid is sensitive to temperature changes. At cooler temperatures, uric acid turns into crystals. Since the toe is the part of the body that is furthest from the heart, it's also the coolest part of the body -- and, thus, the most likely target of gout. However, gout can affect any joint in the body. The tendency to accumulate uric acid is often inherited. Other factors that put a person at risk for developing gout include: high blood pressure, diabetes, obesity, surgery, chemotherapy, stress, and certain medications and vitamins. For example, the body's ability to remove uric acid can be negatively affected by taking aspirin, some diuretic medications ("water pills"), and the vitamin niacin (also called nicotinic acid). While gout is more common in men aged 40 to 60 years, it can occur in younger men and also occurs in women. Consuming foods and beverages that contain high levels of purines can trigger an attack of gout. Some foods contain more purines than others and have been associated with an increase of uric acid, which leads to gout. You may be able to reduce your chances of getting a gout attack by limiting or avoiding the following foods and beverages: shellfish, organ meats (kidney, liver, etc.), red wine, beer, and red meat. Diagnosis In diagnosing gout, the foot and ankle surgeon will take your personal and family history and examine the affected joint. Laboratory tests and x-rays are sometimes ordered to determine if the inflammation is caused by something other than gout. Treatment Initial treatment of an attack of gout typically includes the following: • Medications. Prescription medications or injections are used to treat the pain, swelling, and inflammation. • Dietary restrictions. Foods and beverages that are high in purines should be avoided, since purines are converted in the body to uric acid. • Fluids. Drink plenty of water and other fluids each day, while also avoiding alcoholic beverages, which cause dehydration. • Immobilize and elevate the foot. Avoid standing and walking to give your foot a rest. Also, elevate your foot (level with or slightly above the heart) to help reduce the swelling. The symptoms of gout and the inflammatory process usually resolve in three to ten days with treatment. If gout symptoms continue despite the initial treatment, or if repeated attacks occur, see your primary care physician for maintenance treatment that may involve daily medication. In cases of repeated episodes, the underlying problem must be addressed, as the build-up of uric acid over time can cause arthritic damage to the joint. When is Surgery Needed? In some cases of gout, surgery is required to remove the uric acid crystals and repair the joint. Your foot and ankle surgeon will determine the procedure that would be most beneficial in your case. Enjoy desserts, but in moderation, and if you wake up with a red, hot, swollen, painful foot, call us! Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Diabetic Arthritic Foot (Charcot Foot)

What is Charcot Foot? Charcot foot is a sudden softening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking the foot eventually changes shape. As the disorder progresses, the arch collapses and the foot takes on a convex shape, giving it a rocker-bottom appearance, making it very difficult to walk. Charcot foot is a very serious condition that can lead to severe deformity, disability and even amputation. Because of its seriousness, it is important that patients with diabetes -- a disease often associated with neuropathy -- take preventive measures and seek immediate care if signs or symptoms appear. Symptoms The symptoms of Charcot foot can appear after a sudden trauma or even a minor repetitive trauma (such as a long walk). A sudden trauma includes such mishaps as dropping something on the foot, or a sprain or fracture of the foot. The symptoms of Charcot foot are similar to those of infection. Although Charcot foot and infection are different conditions, both are serious problems requiring medical treatment. Charcot foot symptoms may include: • Warmth to the touch (the foot feels warmer than the other) • Redness in the foot • Swelling in the area • Pain or soreness What Causes Charcot Foot? Charcot foot develops as a result of neuropathy, which decreases sensation and the ability to feel temperature, pain or trauma. When neuropathy is severe, there is a total lack of feeling in the feet. Because of neuropathy, the pain of an injury goes unnoticed and the patient continues to walk -- making the injury worse. People with neuropathy (especially those who have had it for a long time) are at risk for developing Charcot foot. In addition, neuropathic patients with a tight Achilles tendon have been shown to have a tendency to develop Charcot foot. Diagnosis Early diagnosis of Charcot foot is extremely important for successful treatment. To arrive at a diagnosis, the surgeon will examine the foot and ankle and ask about events that may have occurred prior to the symptoms. X-rays are also essential for diagnosis. In some cases, other imaging studies and lab tests may be ordered. Once treatment begins, x-rays are taken periodically to aid in evaluating the status of the condition. Treatment Following the surgeon's treatment plan for Charcot foot is extremely important. Failure to do so can lead to the loss of a toe, foot, leg or life. Treatment for Charcot foot consists of: •Immobilization Because the foot and ankle are so fragile during the early stage of Charcot, they must be protected so the soft bones can repair themselves. Complete non-weightbearing is necessary to keep the foot from further collapsing. The patient will not be able to walk on the affected foot until the surgeon determines it is safe to do so. During this period, the patient may be fitted with a cast, removable boot or brace, and may be required to use crutches or a wheelchair. It may take the bones several months to heal, although it can take considerably longer in some patients. •Custom shoes and bracing Shoes with special inserts may be needed after the bones have healed, to enable the patient to return to daily activities -- as well as help prevent recurrence of Charcot foot, development of ulcers and possibly amputation. Bracing is required in cases with significant deformity. •Activity modification A modification in activity level may be needed to avoid repetitive trauma to both feet. A patient with Charcot in one foot is more likely to develop it in the other foot, so measures must be taken to protect both feet. •Surgery In some cases, surgery may be required. The foot and ankle surgeon will determine the surgical procedure best suited for the patient based on the severity of the deformity and the patient's physical condition. Preventive Care The patient can play a vital role in preventing Charcot foot and its complications by following these measures: •Diabetes patients should keep blood sugar levels under control. This has been shown to reduce the progression of nerve damage in the feet. •Get regular check-ups from a foot and ankle surgeon. •Check both feet every day -- and see a surgeon immediately if there are signs of Charcot foot. •Be careful to avoid injury, such as bumping the foot or overdoing an exercise program. •Follow the surgeon's instructions for long-term treatment to prevent recurrences, ulcers and amputation. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Gout

What is Gout?
Gout is a disorder that results from the build-up of uric acid in the tissues or a joint -- most often the joint of the big toe. An attack of gout can be miserable, marked by the following symptoms:
• Intense pain that comes on suddenly -- often in the middle of the night or upon arising.
• Redness, swelling, and warmth over the joint -- all of which are signs of inflammation.

What Causes Gout?
Gout attacks are caused by deposits of crystallized uric acid in the joint. Uric acid is present in the blood and eliminated in the urine, but in people who have gout, uric acid accumulates and crystallizes in the joints. Uric acid is the result of the breakdown of purines, chemicals that are found naturally in our bodies and in food. Some people develop gout because their kidneys have difficulty eliminating normal amounts of uric acid, while others produce too much uric acid. Gout occurs most commonly in the big toe because uric acid is sensitive to temperature changes. At cooler temperatures, uric acid turns into crystals. Since the toe is the part of the body that is furthest from the heart, it's also the coolest part of the body -- and, thus, the most likely target of gout. However, gout can affect any joint in the body. The tendency to accumulate uric acid is often inherited. Other factors that put a person at risk for developing gout include: high blood pressure, diabetes, obesity, surgery, chemotherapy, stress, and certain medications and vitamins. For example, the body's ability to remove uric acid can be negatively affected by taking aspirin, some diuretic medications ("water pills"), and the vitamin niacin (also called nicotinic acid). While gout is more common in men aged 40 to 60 years, it can occur in younger men and also occurs in women. Consuming foods and beverages that contain high levels of purines can trigger an attack of gout. Some foods contain more purines than others and have been associated with an increase of uric acid, which leads to gout. You may be able to reduce your chances of getting a gout attack by limiting or avoiding the following foods and beverages: shellfish, organ meats (kidney, liver, etc.), red wine, beer, and red meat.

Diagnosis
In diagnosing gout, the foot and ankle surgeon will take your personal and family history and examine the affected joint. Laboratory tests and x-rays are sometimes ordered to determine if the inflammation is caused by something other than gout.

Treatment
Initial treatment of an attack of gout typically includes the following:
• Medications. Prescription medications or injections are used to treat the pain, swelling, and inflammation.
• Dietary restrictions. Foods and beverages that are high in purines should be avoided, since purines are converted in the body to uric acid.
• Fluids. Drink plenty of water and other fluids each day, while also avoiding alcoholic beverages, which cause dehydration.
• Immobilize and elevate the foot. Avoid standing and walking to give your foot a rest. Also, elevate your foot (level with or slightly above the heart) to help reduce the swelling.

The symptoms of gout and the inflammatory process usually resolve in three to ten days with treatment. If gout symptoms continue despite the initial treatment, or if repeated attacks occur, see your primary care physician for maintenance treatment that may involve daily medication. In cases of repeated episodes, the underlying problem must be addressed, as the build-up of uric acid over time can cause arthritic damage to the joint.

When is Surgery Needed?
In some cases of gout, surgery is required to remove the uric acid crystals and repair the joint. Your foot and ankle surgeon will determine the procedure that would be most beneficial in your case.

Testimonials:
“My foot was red, hot and swollen for 2 days. The pain was so intense I could hardly walk. After taking the medication I could walk the next day and the pain was gone in 3 days! It was like a miracle.”
-Richard K.

“When the doctor told me I had gout I couldn’t believe it. I thought only men that drink a lot get gout. Imagine my surprise when the pills for gout worked like a charm.”
-Selma J.


Committed to your health,

Dr. Craig Conti
Sarasota Foot Care Center
http://www.sarasotafootcarecenter.com