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Why is my right toe swollen?

Wednesday, 13 April 2005
Answered by: Professor Anand N. Malaviya
Consultant Rheumatologist,
A & R Clinic,
New Delhi
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Q. I am a 45-year-old male on blood pressure control medicines (Concor 5 mg) for the past 3 years. I am suffering from swelling in the right big toe from the past one year. I used to walk briskly for one hour everyday and lost 10 kg weight. I believe this has caused this problem. Earlier my uric acid was 5.0 while last week it was 6.8. I am a strict vegetarian. I take approximately 2 litres of water daily and have been told to give up beans (pulses) completely. I have been prescribed Naproxen 500 mg to be taken twice daily to reduce the inflammation. Is this a life long problem? Should I give up brisk walking in order to control my excess weight of 10 kg? What should I do to bring down my level of uric acid?

A.  Before any advice can be given, you have to be diagnosed correctly. The commonest cause of swelling with some pain at the base of the big toe is degenerative changes in the joint (osteoarthritis) due to shoes that human race has used for the last several thousands of years. Shoes cause slow and minor injury to the joint at the base of the big toe that leads to prominence of the bone at the base of the big toe with some pain. This is a wear and tear problem that simply requires some modification in the shoes and reassurance to the patients. The second and much rarer condition is a genetic disease of purine metabolism that causes acute severe red-hot swelling appearing at the base of the big toe with excruciating pain and inability to walk, usually associated with fever or a feverish feeling. This condition is called Gout, a disease of men above 40 years of age and usually with a family history, in addition to being overweight, and often with a family history of diabetes, high blood pressure and high blood cholesterol. Gout comes in acute intermittent severe sort-lived attacks (like an emergency). Persons with gouty attacks are more prone to developing heart disease (leading to heart attack). Aspiration of fluid from the inflamed joint shows sodium monourate crystals. Treatment is with standard line of drugs that only a rheumatologist can advice you. Now, you would realise that you need a correct diagnosis and only then the appropriate treatment can be advised. By the way, there is a wide-spread misunderstanding regarding diet in gout. For your convenience I am attaching a document of the American College of Rheumatology that would be helpful to you and your doctor.

A.  Before any advice can be given, you have to be diagnosed correctly. The commonest cause of swelling with some pain at the base of the big toe is degenerative changes in the joint (osteoarthritis) due to shoes that human race has used for the last several thousands of years. Shoes cause slow and minor injury to the joint at the base of the big toe that leads to prominence of the bone at the base of the big toe with some pain. This is a wear and tear problem that simply requires some modification in the shoes and reassurance to the patients. The second and much rarer condition is a genetic disease of purine metabolism that causes acute severe red-hot swelling appearing at the base of the big toe with excruciating pain and inability to walk, usually associated with fever or a feverish feeling. This condition is called Gout, a disease of men above 40 years of age and usually with a family history, in addition to being overweight, and often with a family history of diabetes, high blood pressure and high blood cholesterol. Gout comes in acute intermittent severe sort-lived attacks (like an emergency). Persons with gouty attacks are more prone to developing heart disease (leading to heart attack). Aspiration of fluid from the inflamed joint shows sodium monourate crystals. Treatment is with standard line of drugs that only a rheumatologist can advice you. Now, you would realise that you need a correct diagnosis and only then the appropriate treatment can be advised. By the way, there is a wide-spread misunderstanding regarding diet in gout. For your convenience I am attaching a document of the American College of Rheumatology that would be helpful to you and your doctor.

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