Sesamoiditis versus Gout

[Rebecca Nahid]

I seem to have kept my latest gout flare at bay, either that or it is just a mild flare up that is lingering. Hard to explain but now got a tingling, nagging ache under my big toe which is very similar I believe to sesamoiditis, and wondering could this be a completely different ailment or caused/brought about by gout? It only started yesterday after sitting in the garden on quite a hot day. Thanks

---

Is your foot pain Sesamoiditis or Gout?

[Rebecca Nahid]

Hello there,
It seems to have died down in the last day or so. So maybe it was a tingle relating to gout, which I seem to be keeping at bay at the moment. Although the gout foot in question is still looking suspicious, i.e. the toes are puffy compared to the non gout foot.

No pain today though which is good.

[Keith Taylor]

Personally, I think the relationship of gout to bones is the same wherever they are located. Because uric acid crystals will eventually lead to bone damage in and around affected joints. So, assuming your uric acid is still under control, I’d put this down to minor discomfort from old crystals dissolving. But, if it continues, you should see your doctor with it to rule out any other damage.

The foot is always complicated when it comes to gout. Because there are many conditions that get confused with gout. Especially complicated where these conditions co-exist. So I will continue to add specifics about this particular problem in my Sesamoiditis versus Gout explanations. As a general rule, I’ve noted that the best approach is usually to get uric acid safe. Then you can focus on sesamoids, bunions, or other bone or cartilage defects if they continue once gout is resolved.

[Rebecca Nahid]

Thank you yes that makes a lot of sense I don’t know about where you live but getting a doctor’s appointment here is a nightmare the next routine one is towards the end of October!

[s mags]

Sesamoid Fracture or Gout?

I just want to relate my recent experience and see what others think or what light they may be able to shed on this situation. Because I had a weird first brush with gout and fractured sesamoid.

I am a 45-year-old active male in good shape with decent eating habits. I drink socially, a fair amount of that is beer. I woke up about 6 weeks ago with some pain and discomfort in my big toe. I wasn’t paying very close attention to it. But my impression at the time was that I thought I had slept on it funny. Maybe did something like hyper extend it in my sleep. Or slept with it bent back for a length of time that caused me to wake up sore. It wasn’t incredibly painful though, so I didn’t think too much of it. In fact, I sort of figured the best thing to do was to work and stretch the toe as I normally would. That day I did the orbital machine at the gym as well as some shadowboxing and weightlifting, all of which put pressure on the toe.

I went out for dinner that night and had a few beers (not unusual) and the toe was stiffening up and a bit sore.
I went to bed that night and maybe an hour or two after I fell asleep, I was awoken by excruciating pain. Throbbing, sensitivity etc. I took some anti-inflammatories and iced it. But could barely sleep.
I hobbled to work the next day and taped my toe to restrict the movement of the joint for, what seemed to me, maybe some sort of turf toe.

I did some glancing at gout as a cause. But dismissed it pretty quickly, thinking I was not really a candidate for that and also thinking that fast onset and severe pain, was not consistent with gout. I was wrong about both of those things.

But the taping helped and the pain subsided over the next few weeks. I was able to do yoga and box and was in a little discomfort but not bad pain.
Maybe 5 or 6 weeks after that episode (after 2 long intense bike rides and another workout) the toe pain came back, and I was again having trouble walking. At this point, I found a podiatrist and went in for an appointment.

He took an X-ray which didn’t show anything and said his hunch was that it was gout. But that he would send me for both a blood test and an MRI. I also was given a 5 or 6-day pack of prednisone, an anti-inflammatory steroid.

The steroid cleared the pain up very quickly. I was hopping around barefoot and everything seemed good. The blood test came back before I could schedule an MRI and the uric acid read 8.1 which all seemed to point to a gout attack.
I started wrapping my head around this and immediately cut out several foods as well as making certain I was drinking over 100oz of water a day as well as adding baking soda and apple cider vinegar to my intake.

When the course of prednisone was over, the pain came back with a little swelling. I was able to get the MRI, which showed a fracture on the medial sesamoid.
So now I’m dealing with healing that but am pretty unclear about exactly what I’m dealing with overall. There was no specific incident I can recall in which I feel like I caused the fracture but there is a fracture nonetheless.
Is it possible I fractured the toe and the inflammation from that led to a gout attack? Would a gout attack have weakened the bone and the fracture was secondary?
Is it possible I have 8.1 uric acid but didn’t actually have a gout attack at all?
I’m curious if anyone else has experienced anything similar or has any tips on how to figure this out.

Thanks

[nobody]

I haven’t had an MRI (or X-ray) show a fracture but, in theory…
Is a secondary attack plausible? Yes.
But is it plausible that you don’t have gout at all? Yes.
Is a secondary fracture plausble? No. Or at least: not in your situation.

There are tests that can be used to establish gout (though the most common is normally only attempted when an attack is still going strong) but maybe the most reasonable course of action in your situation is to wait and see. A first gout attack should in theory resolve quickly (certainly much quicker than a fracture). And if you get another attack, except without a fracture this time that will be a big clue.
In the meantime, monitor your uric acid if that is at all practical.

[Author]

Posts