# Intermittent pain/swelling in big toe joint



## mikeridesabike (Feb 16, 2009)

It seems like about once or twice a year, the big toe joint in my right foot swells up and hurts like hell for 4-5 days, then just sort of heals on its own. Meanwhile, I can't ride and walking is pretty painful too. I use a lot of ice and ibuprofen on it.









This seems to happen for no apparent reason. I wear Giro shoes that are plenty wide for my foot, and I don't wear them too tight. I did several 6 hour rides this spring with no problem and then this popped up again after riding 2 hours last Friday and about 3 on Saturday.

I have been tested for gout and told I don't have it. I do have a bit of a bunion in that foot, but it's not that bad and doesn't bother me 95% of the time.

I know that asking strangers on the internet for medical advice is kind of silly, but if anyone has had a similar issue and been able to resolve it, I would love to hear from you.


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## Nat (Dec 30, 2003)

When you were tested for gout, was it via blood work or via sticking a needle in a joint and looking at the fluid under a microscope?


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## mikeridesabike (Feb 16, 2009)

They did a test for uric acid. So it was blood work.


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## Nat (Dec 30, 2003)

Unfortunately checking just blood can be misleading, as you can get a false positive or false negative. Pulling some fluid from the joint is the way to diagnose or rule out gout. That's what you should have done, along with x-rays if you haven't had any. Find a podiatrist or rheumatologist who isn't afraid to aspirate the joint. Anything less is taking a shortcut. You need to get the diagnosis (or rule it out) before you get any further damage to your joints or internal organs.

https://my.clevelandclinic.org/health/diseases/4755-gout/diagnosis-and-tests


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## mikeridesabike (Feb 16, 2009)

Thanks for the information. I will call a podiatrist tomorrow as my go hasn’t been much help.


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## mikeridesabike (Feb 16, 2009)

Nat said:


> Unfortunately checking just blood can be misleading, as you can get a false positive or false negative. Pulling some fluid from the joint is the way to diagnose or rule out gout. That's what you should have done, along with x-rays if you haven't had any. Find a podiatrist or rheumatologist who isn't afraid to aspirate the joint. Anything less is taking a shortcut. You need to get the diagnosis (or rule it out) before you get any further damage to your joints or internal organs.
> 
> https://my.clevelandclinic.org/health/diseases/4755-gout/diagnosis-and-tests


So the podiatrist says gout for sure. He didn't even bother with the needle test - just looked at at that same pic I posted and said gout. As you said, apparently uric acid levels are not the gold standard for this diagnosis. I got a prescription and hopefully that will help.


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## Galeforce5 (Jun 7, 2013)

I have suffered from gout for over 20 years. A few tips for you. I don't know what medication the doc put you on, but some have drawbacks. A few pieces of advice that have served me well.
1. Read up on gout on the web-there's tons of info., and will point you in the direction of what triggers it, esp. food;
2. Drink a lot of water;
3. Buy cherry juice. Cherry juice is one of the best remedies for gout. I purchase cherry juice concentrate by the quart, and drink about 2 oz. a day, stir into a glass of cold water. 
4. If you have a bad attack, cherry juice will put an end to it in a matter of hours. In my case a 1/2 quart of juice. Warning-cherry juice can cause you to have the runs and gas that you won't believe, but it is effective. Just a few pointers from a fellow gout sufferer.


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## Miker J (Nov 4, 2003)

mikeridesabike said:


> So the podiatrist says gout for sure. He didn't even bother with the needle test - just looked at at that same pic I posted and said gout. As you said, apparently uric acid levels are not the gold standard for this diagnosis. I got a prescription and hopefully that will help.


Yeah. Looks pretty classic for gout, and even a normal uric acid level does not rule it out.

Sticking a needle in a small sore joint, while probably the gold standard, is barbaric. Gout can be horrible painful and when I've come at patients with a needle telling them what I'm planning, well...

If there is any question, the " new standard" is a _dual energy CT scan_ of the joint.

As far as treating gout, there can be a lot of variation with the approach to treatment. First thing is to review your med list, if you've been taking chronic meds, to be sure you are not on something that predisposes you too gout. Like some bp meds/diuretics. Especially hydrochlorothiazide (HCTZ).

Good luck.


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## mikeridesabike (Feb 16, 2009)

Thanks everyone! Here's the funny thing - sort of. I had the meds sitting in my medicine cabinet already to fix this. The first time it happened, I went to a walk in clinic and the doc said gout and prescribed Colcyrs. That helped a lot. Then the next time, I went to my GP and he did the uric acid test and said it wasn't gout. So I have been going around for 5 years thinking this was not gout, even as it flared up fairly regularly.

So when I went to the podiatrist this time, he prescribed the exact same thing as the guy from 5 years ago and it turns out I still had about 15 or 20 pills sitting in the medicine cabinet. I started taking those and my foot is much better now. My GP is a good doc, but I guess he is not an expert on gout.

I am going to get some of that cherry juice concentrate and start taking it.


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