[size=4][b]Toe Gout - Gout- Warning Signs[/b][/size][hr]Gout attack strikes when you least expected it, that is to say at night. When you are sleeping peacefully, you suddenly feel some tenderness in the large joint of your big toe. That is a gout flare. That area suddenly becomes swollen, red and extremely painful. You might also develop a fever when suffering from a gout flare. The next 24 hours will also be very painful when having a gout. :o.
You can have your gout treated, but it does not make any difference when it come to symptoms. The gout symptoms will actually go away in about one week, even if you do not treat your gout signs. Furthermore, there is always the chance that you will not suffer from another gout flare again. However, if you do suffer from other gout forums, this do not look so good for you. As time passes, the gout attacks become more painful. There is also the risk that if suffering from more than one gout attack, the duration of the attacks increases with time. As you progress deeper and deeper into this composition on Information Gout, you are sure to unearth more information on Information Gout. The information becomes more interesting as the deeper you venture into the composition.
[size=large][b]Almost Ninety Percent of All Gout Patients, Suffer from Flares in the Big Toe[/b][/size][hr]However, gout attacks may happen in other joints, like the knee, fingers, wrist. The gout signs are the same no matter the location of the attack. There are universal applications on Gout Attacks everywhere. However, it is up to us to decide the way used for these applications to get the best results from them.
[size=large][b]When Suffering from a Gout, There are More Factors of Risk Involved[/b][/size][hr]However, one of those factors is the head of the list when talking about a gout attack. Elevated uric acid levels in your blood, also know as hyperuricemia is the main risk in a gout. All people who suffer from this condition are predisposed to having a gout flare. As your levels of acid rise in your blood, so does the risk of having a gout attack. Furthermore, this gout flare is very unpredictable. No one can say for sure when you are likely to have a gout attack. However, there are some factors that are thought to trigger the gout flare. Certain medicines, alcohol, stress and some other medical problems that you might suffer from may trigger a gout. Even if such factors are thought to be the ones responsible for a gout attack, there are many times that neither you nor your doctor can say for sure what was the cause of your gout flare. To predict the time of the chances of you having a gout attack can be done. This is not quite certain, but it may give you an idea. all you have to do is visit your doctor and have your levels of uric acid measured. This is the way to predict if you are likely to suffer from a gout attack in the future or not. Saying that all that is written here is all there is on Uric Acid would be an understatement. Very much more has to be learnt and propagated bout Uric Acid.
[size=large][b]Turf Toe Gets No Respect[/b][/size][hr]Let's take a closer look at the causes of turf toe and see how to treat it more effectively. Turf toe is actually a form of hallux limitus. Hallux limitus is classically described as pain and progressive decrease in the range of motion of the first metatarsal phalangeal joint (MPJ). The onset of hallux limitus is due to the following:
What's the actual physical change that takes place in the joint with turf toe? As an easy analogy, consider the changes that takes place when an apple falls from a height and is damaged. The skin of the apple appears intact but the underlying pulp is damaged. In the case of turf toe (hallux limitus), think of the skin of the apple as the cartilage of the joint and the damaged pulp of the apple is the subchondral bone. Mild cases of turf toe (hallux limitus), result in little damage to the subchondral bone and will merely exhibit signs of inflammatory change within the joint. Most authors would refer to these cases as stage one turf toe (hallux limitus). More severe cases result in damage to the joint surface, the subchondral bone or both. These are the stage two and three cases of turf toe (hallux limitus) that show visible change on x-ray. As the subchondral bone becomes increasingly damaged, it will create an uneven supporting surface for the cartilage. An increase in activity results in uneven loading of the joint due to the compression injury of the subchondral bone. It was with great optimism that we started out on writing this composition on Gout Joint. Please don't let us lose this optimism.
Think of turf toe (hallux limitus) as an isolated case of osteoarthritis limited to the first MPJ. Whether the injury is acute or due to repetitive loading, the result is a load that is applied to the subchondral bone that is greater than what the bone can tolerate. As the injury progresses, a series of micro fractures will develop in the subchondral bone. The typical soft spongy character of the metaphyseal bone changes to become brittle and hard. The result is that the articular cartilage looses its' underlying support and becomes susceptible to damage. Juxtachondral eburnation, osteophytes, lipping, spurring; call them what you like, but what you see on your x-ray is the slow progressive destruction of the joint. Patience was exercised in this article on Gout. Without patience, it would not have been possible to write extensively on Gout.
[size=large][b]Turf Toe Caused by a Direct Injury to the Joint May or May Not be Obvious[/b][/size][hr]Athletes may not remember an incident of pain since they're often distracted by the event or game in which they're involved. The onset of direct injury to the joint may be abrupt, but also may be insidious becoming increasingly more painful as the season progresses. The joint pain will subside with rest only to recur with increased activity. It's not unusual to see symptoms of turf toe resolve in the off season only to recur with renewed exercise.
[i]Nomenclature: First MPJ - the big toe joint Metatarsus primus elevatus - a functional or structural position of the first metatarsal First metatarsal - the foot bone making up the proximal portion of the big toe joint Hallux - the great toe[/i]
The onset of turf toe always the same? Turf toe that is the result of functional hallux limitus is going to be insidious in onset. Functional hallux limitus will usually be seen in younger athletes as they attempt to increase their activity. It may not occur during the first athletic season, or the second, but when it does begin to cause pain, the onset will be more frequent and more severe, varying with activity. This profile of onset is simply due to the fact that the athlete is recreating the injury with every step.
Treatment of turf toe varies with the type of healthcare provider and includes the use of rest, shoe modifications, orthotics, steroid injections and surgery. The success of non-surgical care will vary with the degree of injury, the rate at which the injury is healing and how much osteoarthritis has occurred. We see varying degrees of success with orthotics that promote plantarflexion of the first ray, effectively treating metatarsus primus elevatus and peroneus longus dysfunction. Simple arch supports can make a significant difference in the symptoms of turf toe. Should our patient not respond to conservative care in a reasonable time period, we are not reluctant to suggest surgical revision to address the problem whether it be revisions of the joint defect, shortening of a long first metatarsal or structural revision of metatarsus primus elevatus. As mentioned before, the clinical appearance of dorsal lipping or visible radiographic changes are suggestive of moderately advanced osteoarthritis, a condition that is only repaired by joint revision or replacement.
[b]Other conditions - synovitis, crystal deposition diseases such as gout, systemic arthritis, external physical influences such as Dupytren's contracture, etc.[/b]
<hr> Symptoms: Turf toe that is the result of functional hallux limitus is going to be insidious in onset. Functional hallux limitus will usually be seen in younger athletes as they attempt to increase their activity. It may not occur during the first athletic season, or the second, but when it does begin to cause pain, the onset will be more frequent and more severe, varying with activity. This profile of onset is simply due to the fact that the athlete is recreating the injury with every step. Turf toe caused by a direct injury to the joint may or may not be obvious. Athletes may not remember an incident of pain since they're often distracted by the event or game in which they're involved. The onset of direct injury to the joint may be abrupt, but also may be insidious becoming increasingly more painful as the season progresses. The joint pain will subside with rest only to recur with increased activity. It's not unusual to see symptoms of turf toe resolve in the off season only to recur with renewed exercise. We have actually followed a certain pattern while writing on Gout Joint. We have used simple words and sentences to facilitate easy understanding for the reader.
<hr> Anatomy: The great toe joint, or first metatarsal joint consists of two bones. The proximal bone is the first metatarsal and the distal is called the proximal phalanx or hallux. These two bone move against each other in an up and down motion through what we refer to as the sagital plane. Biomechanics: The motion of the great toe joint is dependant upon the plantarflexion of the first metatasal. If the first metatarsal is limitied in its' ability to plantarflex, the joint will jam resulting in funtional hallux limitus, which as we know is one of the causes of turf toe. Penetration into the world of Gout Joint proved to be our idea in this article. Read the article and see if we have succeeded in this or not!
.
[list][*]<hr> Differential Diagnosis: The differential diagnosis of turf toe includes;[*]Arthitis Fracture Gout Joint infection Joint or bone tumor Synovitis [/list]
Unger, K., Rahimi, F., Bareither, D., Muehleman, C. The Relationship Between Articular Cartilage Degeneration and Bone Changes of the First Metatarsophalangeal Joint. J. Foot Surg. 39:1 24-33, 2000
[size=large][b]Functional Hallux Limitus[/b][/size][hr]Biomechanical function that results in metatarsus primus elevatus and subsequent repetitive jamming of the first MPJ. Direct physical injury - injury to the articular cartilage or subchondral bone. These injuries may be due impaction injuries or hyperextension/flexion of the first MPJ. We consider that we have only touched the perimeter of information available on Diseases Gout. There is still a lot more to be learnt!.
But before we go any further, we need to understand that the terms turf toe and hallux limitus aren't really synonymous. The fundamental difference between the two terms is the patient population that they affect. Turf toe is a term used in athletic circles referring to any injury of the great toe joint. Consequently, discussions about turf toe will focus on the first two causes of hallux limitus mentioned above; functional hallux limitus and direct physical injury. On the other hand, kidney stone disease hallux limitus, we're actually referring to a broader, 'non-athletic' patient population and need to include all three causes of hallux limitus.
When treating turf toe be sure to recognize the fact that there is no nerve innervation in articular cartilage. Pain associated with stage one turf toe (hallux limitus) is either synovial pain or bone pain. If we recognize that painful stage one turf toe (hallux limitus) may be due to bone pain, we then realize that turf toe should be treated aggressively to insure the long term viability of the joint.
References: Lombardi, C.M., Silhanek, A.D., Connolly, F.G., Dennis, L.N., Keslonsky, A.J. First Metatarsophalangeal Arthrodesis for Treatment of Hallux Rigidus: A Retrospective Study. J. Foot Surg. 40:3, 137-143, 2001
You can have your gout treated, but it does not make any difference when it come to symptoms. The gout symptoms will actually go away in about one week, even if you do not treat your gout signs. Furthermore, there is always the chance that you will not suffer from another gout flare again. However, if you do suffer from other gout forums, this do not look so good for you. As time passes, the gout attacks become more painful. There is also the risk that if suffering from more than one gout attack, the duration of the attacks increases with time. As you progress deeper and deeper into this composition on Information Gout, you are sure to unearth more information on Information Gout. The information becomes more interesting as the deeper you venture into the composition.
[size=large][b]Almost Ninety Percent of All Gout Patients, Suffer from Flares in the Big Toe[/b][/size][hr]However, gout attacks may happen in other joints, like the knee, fingers, wrist. The gout signs are the same no matter the location of the attack. There are universal applications on Gout Attacks everywhere. However, it is up to us to decide the way used for these applications to get the best results from them.
[size=large][b]When Suffering from a Gout, There are More Factors of Risk Involved[/b][/size][hr]However, one of those factors is the head of the list when talking about a gout attack. Elevated uric acid levels in your blood, also know as hyperuricemia is the main risk in a gout. All people who suffer from this condition are predisposed to having a gout flare. As your levels of acid rise in your blood, so does the risk of having a gout attack. Furthermore, this gout flare is very unpredictable. No one can say for sure when you are likely to have a gout attack. However, there are some factors that are thought to trigger the gout flare. Certain medicines, alcohol, stress and some other medical problems that you might suffer from may trigger a gout. Even if such factors are thought to be the ones responsible for a gout attack, there are many times that neither you nor your doctor can say for sure what was the cause of your gout flare. To predict the time of the chances of you having a gout attack can be done. This is not quite certain, but it may give you an idea. all you have to do is visit your doctor and have your levels of uric acid measured. This is the way to predict if you are likely to suffer from a gout attack in the future or not. Saying that all that is written here is all there is on Uric Acid would be an understatement. Very much more has to be learnt and propagated bout Uric Acid.
[size=large][b]Turf Toe Gets No Respect[/b][/size][hr]Let's take a closer look at the causes of turf toe and see how to treat it more effectively. Turf toe is actually a form of hallux limitus. Hallux limitus is classically described as pain and progressive decrease in the range of motion of the first metatarsal phalangeal joint (MPJ). The onset of hallux limitus is due to the following:
What's the actual physical change that takes place in the joint with turf toe? As an easy analogy, consider the changes that takes place when an apple falls from a height and is damaged. The skin of the apple appears intact but the underlying pulp is damaged. In the case of turf toe (hallux limitus), think of the skin of the apple as the cartilage of the joint and the damaged pulp of the apple is the subchondral bone. Mild cases of turf toe (hallux limitus), result in little damage to the subchondral bone and will merely exhibit signs of inflammatory change within the joint. Most authors would refer to these cases as stage one turf toe (hallux limitus). More severe cases result in damage to the joint surface, the subchondral bone or both. These are the stage two and three cases of turf toe (hallux limitus) that show visible change on x-ray. As the subchondral bone becomes increasingly damaged, it will create an uneven supporting surface for the cartilage. An increase in activity results in uneven loading of the joint due to the compression injury of the subchondral bone. It was with great optimism that we started out on writing this composition on Gout Joint. Please don't let us lose this optimism.
Think of turf toe (hallux limitus) as an isolated case of osteoarthritis limited to the first MPJ. Whether the injury is acute or due to repetitive loading, the result is a load that is applied to the subchondral bone that is greater than what the bone can tolerate. As the injury progresses, a series of micro fractures will develop in the subchondral bone. The typical soft spongy character of the metaphyseal bone changes to become brittle and hard. The result is that the articular cartilage looses its' underlying support and becomes susceptible to damage. Juxtachondral eburnation, osteophytes, lipping, spurring; call them what you like, but what you see on your x-ray is the slow progressive destruction of the joint. Patience was exercised in this article on Gout. Without patience, it would not have been possible to write extensively on Gout.
[size=large][b]Turf Toe Caused by a Direct Injury to the Joint May or May Not be Obvious[/b][/size][hr]Athletes may not remember an incident of pain since they're often distracted by the event or game in which they're involved. The onset of direct injury to the joint may be abrupt, but also may be insidious becoming increasingly more painful as the season progresses. The joint pain will subside with rest only to recur with increased activity. It's not unusual to see symptoms of turf toe resolve in the off season only to recur with renewed exercise.
[i]Nomenclature: First MPJ - the big toe joint Metatarsus primus elevatus - a functional or structural position of the first metatarsal First metatarsal - the foot bone making up the proximal portion of the big toe joint Hallux - the great toe[/i]
The onset of turf toe always the same? Turf toe that is the result of functional hallux limitus is going to be insidious in onset. Functional hallux limitus will usually be seen in younger athletes as they attempt to increase their activity. It may not occur during the first athletic season, or the second, but when it does begin to cause pain, the onset will be more frequent and more severe, varying with activity. This profile of onset is simply due to the fact that the athlete is recreating the injury with every step.
Treatment of turf toe varies with the type of healthcare provider and includes the use of rest, shoe modifications, orthotics, steroid injections and surgery. The success of non-surgical care will vary with the degree of injury, the rate at which the injury is healing and how much osteoarthritis has occurred. We see varying degrees of success with orthotics that promote plantarflexion of the first ray, effectively treating metatarsus primus elevatus and peroneus longus dysfunction. Simple arch supports can make a significant difference in the symptoms of turf toe. Should our patient not respond to conservative care in a reasonable time period, we are not reluctant to suggest surgical revision to address the problem whether it be revisions of the joint defect, shortening of a long first metatarsal or structural revision of metatarsus primus elevatus. As mentioned before, the clinical appearance of dorsal lipping or visible radiographic changes are suggestive of moderately advanced osteoarthritis, a condition that is only repaired by joint revision or replacement.
[b]Other conditions - synovitis, crystal deposition diseases such as gout, systemic arthritis, external physical influences such as Dupytren's contracture, etc.[/b]
<hr> Symptoms: Turf toe that is the result of functional hallux limitus is going to be insidious in onset. Functional hallux limitus will usually be seen in younger athletes as they attempt to increase their activity. It may not occur during the first athletic season, or the second, but when it does begin to cause pain, the onset will be more frequent and more severe, varying with activity. This profile of onset is simply due to the fact that the athlete is recreating the injury with every step. Turf toe caused by a direct injury to the joint may or may not be obvious. Athletes may not remember an incident of pain since they're often distracted by the event or game in which they're involved. The onset of direct injury to the joint may be abrupt, but also may be insidious becoming increasingly more painful as the season progresses. The joint pain will subside with rest only to recur with increased activity. It's not unusual to see symptoms of turf toe resolve in the off season only to recur with renewed exercise. We have actually followed a certain pattern while writing on Gout Joint. We have used simple words and sentences to facilitate easy understanding for the reader.
<hr> Anatomy: The great toe joint, or first metatarsal joint consists of two bones. The proximal bone is the first metatarsal and the distal is called the proximal phalanx or hallux. These two bone move against each other in an up and down motion through what we refer to as the sagital plane. Biomechanics: The motion of the great toe joint is dependant upon the plantarflexion of the first metatasal. If the first metatarsal is limitied in its' ability to plantarflex, the joint will jam resulting in funtional hallux limitus, which as we know is one of the causes of turf toe. Penetration into the world of Gout Joint proved to be our idea in this article. Read the article and see if we have succeeded in this or not!
.[list][*]<hr> Differential Diagnosis: The differential diagnosis of turf toe includes;[*]Arthitis Fracture Gout Joint infection Joint or bone tumor Synovitis [/list]
Unger, K., Rahimi, F., Bareither, D., Muehleman, C. The Relationship Between Articular Cartilage Degeneration and Bone Changes of the First Metatarsophalangeal Joint. J. Foot Surg. 39:1 24-33, 2000
[size=large][b]Functional Hallux Limitus[/b][/size][hr]Biomechanical function that results in metatarsus primus elevatus and subsequent repetitive jamming of the first MPJ. Direct physical injury - injury to the articular cartilage or subchondral bone. These injuries may be due impaction injuries or hyperextension/flexion of the first MPJ. We consider that we have only touched the perimeter of information available on Diseases Gout. There is still a lot more to be learnt!
.But before we go any further, we need to understand that the terms turf toe and hallux limitus aren't really synonymous. The fundamental difference between the two terms is the patient population that they affect. Turf toe is a term used in athletic circles referring to any injury of the great toe joint. Consequently, discussions about turf toe will focus on the first two causes of hallux limitus mentioned above; functional hallux limitus and direct physical injury. On the other hand, kidney stone disease hallux limitus, we're actually referring to a broader, 'non-athletic' patient population and need to include all three causes of hallux limitus.
When treating turf toe be sure to recognize the fact that there is no nerve innervation in articular cartilage. Pain associated with stage one turf toe (hallux limitus) is either synovial pain or bone pain. If we recognize that painful stage one turf toe (hallux limitus) may be due to bone pain, we then realize that turf toe should be treated aggressively to insure the long term viability of the joint.
References: Lombardi, C.M., Silhanek, A.D., Connolly, F.G., Dennis, L.N., Keslonsky, A.J. First Metatarsophalangeal Arthrodesis for Treatment of Hallux Rigidus: A Retrospective Study. J. Foot Surg. 40:3, 137-143, 2001