Q: I have been suffering from joint pain in my big toe of the right foot for the past 2 years. I have been told that it is gouty arthritis. But my serum uric acid has always been within the normal range. How to diagnose the problem? Do I need to take life long medication for this? Such events recur in spite of dietary modification as advised by my orthopaedic surgeon. Please advise.

A:The commonest cause of pain at the base of the big toe is wear-and-tear due to mechanical stress of walking and the use of shoes. This condition is called osteoarthritis of the first metatarsophalangeal joint. It is amazing that those who have never used shoes, never get this type of wear-and-tear at the base of the big toe. It is also very surprising that while rheumatologists (physicians specialised in the field of joint and musculoskeletal diseases) know about this simple mechanical-stress related problem at the base of the big toe, some doctors may misdiagnose it as gout. This is why many such patients are wrongly given allopurinol, a drug that does not give any relief in the type of problem that you have. Therefore, I strongly recommend that you find out a rheumatologist and get the condition properly diagnosed and managed. Possibly the rheuematologist would refer you to a podiatrist who will correct the mechanical stress factors by appropriate footwear and advise certain exercises, as well.