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Sudden swelling in left foot.. = gout ??

Discussion in 'Ask your questions here' started by Sinoed, Aug 8, 2010.

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  1. Sinoed

    Sinoed New Member


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    Hello all, I'm hoping that someone can shed a bit of light on my problem or has experienced something similar so that I can ask the right questions and get the right tests.

    I'm a 31 year old female, non smoker, non drinker, suffering from a sudden onset of swelling and pain in the top of my left foot. I don't remember falling or dropping anything on the top of my foot so I thought it was possible that I had twisted or sprained something. I waited for a few days keeping it elevated where possible, icing it and generally tried to stay off my feet but it didn't improve so I went in to see the doctor on July 22. He flexed my foot from left to right and the pain was so intense I was physically sick and had to hobble to the bathroom. He prescibed tylenol 3 for the pain and ordered a battery of blood tests and an ultrasound because he thought that the 'veins were inflamed' or that it could be a blood clot. I followed up with him on July 26 and the blood tests were all fine (kidney, liver and thyroid function, CBC, vitamins, PTT, cholesterol.. pretty much everything) and although the 'official' results from the ultrasound won't be complete for another week or two I was told if I did have a clot I would have been going into ER so I'm ok. He told me to wait another week or so then come back and see him if I was still having trouble.

    I went to see another doctor July 31 because his clinic was open on Saturday and I wasn't very confident with the first doctor, and told him what had happened so far. He ordered xrays and a blood test for gout and prescribed Colchicine at 0.6mg once per day. I've now been on the Colchicine for a week and was back in to see him yesterday August 7 to find out that the xrays are clear. The test for gout will be done by next Tuesday.

    I still have an area the size of a quarter on the top of my foot that is incredibly tender and painful to touch. It seems to swell first and then spreads throughout the rest of my left foot after walking or putting weight on it. Its not swollen in the morning when I wake up, isn't hot and I don't have a burning sensation or bruising. My foot is slightly less swollen then last week but I have also been restricted at work, no walking, keeping my foot elevated during the day and icing it. I don't do any extra curricular activities right now and just come home and rest it.

    Is it possible that this could be gout..? To me three weeks seems like a long time for a gout attack but I've never run into anything like this before. I'm not entirely convinced that the Colchicine he prescribed is working vs. my self imposed restrictions. Aside from the blood test is there any way to measure whether this stuff is working? How long would it normally take for Colchicine to resolve an acute case of Gout? Are there other tests that I should be having done? I have another appointment with the doctor on Friday and if the gout tests come back clear (and I suspect they will) I'm not sure where to go next. Any help or advice is very much appreciated - thank you in advance.
     
    Last edited: Aug 8, 2010
  2. FootDoc

    FootDoc New Member

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    It sound to me as though your doctors have absolutely no clue as to your diagnosis and are merely on a fishing expedition, throwing the kitchen sink at you in the form of tests, hoping that some test will inadvertently turn up something that their diagnostic abilities could not.

    Colchicine 0.6 mg only once daily is not generally the dosage that would be employed to break an acute gouty attack, and if the gout test you are awaiting is a serum uric acid determination, it may not, in my view, be of real diagnostic value if you've already been on gout medication. Uric acid determinations are not necessarily definitive anyhow, and the gold-standard test for acute gout is aspiration of the joint fluid and demonstration of urate crystals under a microscope.

    Have you had a recent infection or an insect bite? Have you considered seeing a rheumatologist?
     
    Last edited: Aug 8, 2010
  3. Sinoed

    Sinoed New Member

    Thanks Foot Doc, that post was very helpful. I've been a little concerned about all these tests with no real diagnosis and I'm not particularly happy taking Colchicine because *it might be* gout. From what I researched on the internet I understood that acute gout attacks didn't usually last more than ten days and also that Colchicine should have started helping dramatically in 12-24 hours. The gout test I'm waiting for _is_ actually a serum uric acid determination which is why I'm pretty sure it will be fine - because otherwise I think the Colchicine would have been helping by now. I haven't had a recent infection or insect bite so I'm ok as far as that goes.

    I hadn't considered seeing a rheumatologist yet because I wasn't sure if I need to see a podiatrist first? It seems to get worse throughout the day after I've been standing or walking so I wasn't sure if it could be something like a stress fracture and don't know if thats possible where I have pain. (From looking at diagrams it hurts around the lateral cuneiform and the 3rd and 4th metatarsal).

    I absolutely detest the thought of another blood test but do you know if there something that I could ask them to check that would help point me in one direction or the other?
     
  4. FootDoc

    FootDoc New Member

    The direction which a skilled diagnostician takes in determining the cause of a patient's complaint is based on a consideration of the totality of the history, the symptoms as related by the patient and the findings which the patient brings to the party. Very important is that the patient be able to offer a really well defined history of all events surrounding the time line of the condition and not simply those which he/she considers relevant as well as being able to accurately express symptoms (non-visible aspects of the condition known only to him/her) in a manner which can be universally understood by the diagnostician. Forums such as this where the words of the patient can paint only a one-dimensional picture of the condition do not really lend themselves to anything but guesses which can not be properly tested. In the case of swelling with pain, the diagnostician must first determine what category of illness is at hand . . whether it be associated with infection or physical injury of some sort or thrombosis of veins or arterial insufficiency or some sort of inflammatory arthritis, reactive arthritis or constitutional reaction. In my view, simply conducting a battery of tests without real direction as to what relevant condition is being ruled in or out is like digging for gold at random sites without any reason to believe that it can be found there. Diagnosis is a skill based on experience and the carefully listening to all of the "sounds" which the condition offers. It often requires all five senses of the diagnostician and it can be similar to a skilled detective's solving of a crime. I can't say that I could diagnose your case any better than can your own doctors, but I can say that I would take a more directed and targeted approach than what I infer from your story as you have related it is being taken by your doctors, assuming that YOU have related it with clear precision.
     
    Last edited: Aug 8, 2010
  5. Sinoed

    Sinoed New Member

    Thanks. Its foolish to try to diagnose anything via the internet - you simply can't apply proper clinical techniques to resolve any issues or offer advice on a condition that you can't see. Frankly, as a patient it wouldn't be wise to ask or follow advice from someone who thought they could. However, your post did provoke some thought - perhaps the problem is that the doctors I've seen have yet to figure out what 'category' the swelling and pain belongs to. Maybe the better question might be not what tests should be done to resolve it, but why certain tests need to be done. Its possible that seeing a podiatrist would be a better avenue at this point - since he/she may be able to resolve the 'category' this best fits under rather than undergoing irrelevant testing.
     
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