A 50 year old male patient came in yesterday presenting with intense joint pain around the heel, redness/inflammation around the back of the ankle, and pin point tenderness and lingering discomfort in the back of the heel.
The patient sat down in my treatment room and explained that his medical doctor ordered an x-ray for his foot a couple days back. The x-ray came back with a report indicating a heel spur located around the achilles tendon attachment site at the back of the ankle. The doctor explained that this is probably the reason for the redness and pin point pain over the area. The patient is content that he has an explanation as per the cause of his pain, however is still confused as to why he gets this pain in the heel every 3-4 months and does not know how to treat the pain. Furthermore, he doesn’t understand why this pain affects other joints (elbow, knee and forearm) and makes him feels extremely stiff in his neck and back.
After a lengthy health history, physical assessment and discussion about his other locations of joint pain, we came to a conclusion. The pain and redness in the joint areas, come on after vacations and cottage trips. At first, he thought that perhaps he over does it during his vacations / trips to the cottage and thus the reason for the pain. After thorough evaluation of his health history we came to a very important conclusion and discovery. During his getaways, the patient eats a high volume of seafood (scallops, lobster, etc.) drinks large quantities beer and indulges in organ meet. All these food items have a high level of purine. Purine is broken down by our body into uric acid. When we have plenty of uric acid (too much), this extra uric acid can form into urate crystals which accumulate in the joints. Normally, uric acid dissolves in your blood and this passes through your kidneys into your urine. Sometimes, however, your body either produces too much uric acid or your kidneys excrete too little uric acid and when this happens, uric acid can build up. The build up of uric acid can form sharp, needle-like urate crystals (called TOPHI) in a joint or surrounding tissue that cause pain, inflammation and swelling. My patient had a tophi at the back of his heel! All these signs and symptoms are what we call GOUT. Gout which is a complex form of arthritis can affect anyone however here are some risk factors listed below.
Risk Factors for Gout
Foods such as anchovies, herring, asparagus, mushrooms, roast beef, turkey, seafood (scallops), beer have high levels of purine and should be avoided by those who have familial history of gout and/or previous episodes of gout. Risk factors of gout include: lifestyle factors (excessive alcohol use), medical conditions (high levels of fat and cholesterol), certain medications (diuretics used to treat hypertension), family history of gout and age (40-50) and sex (male more than females).
Severity of Gout
My patient has something called advanced gout. Recurrent gout comes and goes (depending on diet) and can be treated with medications/exercise and diet modification. Advanced gout occurs when recurrent gout goes untreated and as a result the body deposits urate crystals to form under the skin in nodules called tophi (TOE-fi). Tophi usually aren’t painful, but they can become swollen and tender during gout attacks. Kidney stones are more serious and will form if urate crystals collect in the urinary tract.
After a lengthy discussion about his condition, the patient went back to the medical doctor for the appropriate medical prescription(s). In the meantime, the patient wanted to start a diet and exercise program with our clinic. We developed a program for the patient and also incorporated some registered massage therapy along with some chiropractic stretch techniques to assist with stiffness in the body. The patient felt much better after six treatment sessions and is extremely happy that he now understands his health issue and how he can prevent it from re-occurring.
MEDICAL DISCLAIMER: The following information is my personal notes about this subject matter. It is intended for informational purposes only. Consult a health practitioner to help you diagnose and treat injuries of any kind.
Dr. Luciano Di Loreto, HBSc., DC
Chiropractor in Woodbridge, Ontario