Keith’s GoutPal Story 2020 Forums Please Help My Gout! diagnosis – gout v.podagra v. hallux

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    Al O’Purinol

    Hello, I am confused and my doctor is no help.

    I am 60 year old female. I had my first  gout attack at the beginning of this year (sudden pain, swelling, lasted about a week) I  had blood test for UA which confirmed higher levels and was given Indomethacin.

    In the last few months I have experienced some pain and discomfort which would go away after a few days. I associated this with the small bunion (hallux) I have on my right foot (same place as the gout attack).

    My Doctor thinks it is the gout. He refused to do another Uric acid blood test saying it would only tell us that the Uric acid is higher than normal and again prescribed Indomethacin for future use.

    How to distinguish between gout rumblings and pain from the inflamed bunion joint? What is podagra – I thought it was another name for gout?

    How to approach my doctor to get some tests done? Can I insist to be referred to rheumatologist or perhaps orthopedic consultant to get proper diagnosis? Is this the right course of action?

    Thanks for any help and advice.Confused

    Bone Spur, Bunion, or Gouty Tophus photo?
    Do you know why your big toe is red, swollen, and painful?

    It would help to have the uric acid numbers.

    Everything you've said indicates gout, but only a proper examination would confirm this or prove otherwise.

    If you are not happy, you absolutely must insist on seeing a rheumatologist. Indomethacin will ease the pain, but do absolutely nothing to halt your gout.


    Haldan: You pay the Md. If they dont want to treat you find another, your the one in pain. If you parked your car on his foot I would bet he'd beg to get the pain relieved. Goutpal has mentioned a uric acid tester somewhere on this site. You might want to look into that.


    Hi Haldan,

    I can understand your confusion as I have gone through it for last 6 months. My gout was triggered due to toe injury( fracture). My diagnosis has been all confused with Bursitis to Hallux Limitus to Gout. My pain was never typical of gout as I was able to bend my toe down without any pain but the upward movement was painful( it is still somewhat painful though better). Besides my pain was always when I put my foot down on ground, I never had pain while resting.

    The gout was considered as Colchicine worked ( I took 2 tabs a day) and Uric Acid was 9.2.

    I am treated with Allopurinol 300 mg and my current SUA levels are below 4. At the same time, I got treated for fracture with Post Op shoes, Toe therapy and many other things.

    As I still have some pain while walking and moving the toe up, which improves a lot with a orthotic and sleeve, I am told that there is also a minor Hallux Limitus, due to toe bumping and possible gout.

    Now one of the doctors feel that I probably never had gout ( and if I had it was a very minor flare of gout), while the other feels it was gout that made the fracture recovery worse. I have shown to GP and Podiatry both.

    So, instead of suffering more, I am taking both the treatments – Allopurinol 300 mg and also toe treatment. Things have improved a lot with my SUA levels averaging below 4 and toe movement becoming better with passage of time.

    I guess, doctors have their own limitations as our symptoms point to more than one condition and the diagnostics are not conclusive.


    @Dan – The uric acid tester is covered in the first post of the Uric Acid forum. There are also other discussions dotted around. It is good, but no substitute for proper medical care. I would always recommend the rheumatologist option whenever things are not straightforward. The meter's are great if you want to stay assured between doctor visits, and don't mind the expense.

    @Utubelite – good ideas, and nice closing paragraph. A man's gotta know his limitations.


    Now one of the doctors feel that I probably never had gout.

    I have found a school of doctors who will not believe you have a disease unless THEY diagnose it. So for a new doctor, I suppose we are expected to discontinue allopurinol and crawl inn with a big red toe and say “SEE.” It is for these doctors that the phrase “smack upside the head” was invented.

    Al O’Purinol

    Hi All,

    thank you All for your input. I would consider looking for another GP if I don’t get referred to a rheumatologist. Same as Utubelite I only have pain when I put my foot on the ground, I have no pain while resting.

    Could someone answer my other question – is podagra another name for gout?


    @Goutpal. I agree with you. I mentioned the tester because in the USA alot of health care programs only allow blood test every 3-4 months unless you are in a hosiptal


    @Haldan – podagra is gout in the foot – stupid term really because it might start in the foot (for most people), but untreated will hit every joint.

    @Dan – Isn't it strange how you can be protected from buying generic colchicine (which is perfectly safe) by government agencies, yet those agencies do nothing to protect you from allopurinol and other urate lowering therapies without adequate uric acid testing (which is imperfectly dangerous).Confused


    Haldan said:

    Post edited 6:24 pm – November 24, 2009 by Haldan

    Hi All,

    thank you All for your input. I would consider looking for another GP if I don't get refered to a rheumatologist. Same as Utubelite I only have pain when I put my foot on the ground, I have no pain while resting.

    Could someone answer my other question  – is podagra another name for gout?

    Hi Haldan,

    The difference I want to point out here is that my episode started with toe injury, that's why all this confusion. Without injury, it would have been direct Gout diagnosis.


    Could someone answer my other question  – is podagra another name for gout?

    Podagra is the word used to describe the easily recognized gout attack that is extraordinarily painful whether moving or not, hits precisely the bunion joint of the big toe, and is red (or purple) and swollen. This is the classic gout that doctors (and barbers and shamans) 2,000 years ago could recognize before they even knew that blood circulation, the immune system, or even  uric acid existed. Rarely similar symptoms can arise from pseudogout.

    It is the commonest marker for gout and eventually, almost to a man, a gout sufferer will suffer a bout of podagra…and usually swear NEVER AGAIN…and then swear some more. It hurts like HELL!


    A better name for gout?

    Who thinks gout doesn’t get taken seriously? Maybe it’s the name.

    Anyone got anything better than P-JODD?

    Progressive Joint and Organ Damage Disease


    Clutch-toe has been suggested

    Keith Taylor

    As far as podagra is concerned, I’ve included it with other ancient names for gout.

    Though it’s incidental to the main part of the article – we’d get better treatment if we stopped talking about gout. Instead, use Uric Acid Arthritis, or some other name that encourages serious treatment.

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