The Season for Acute Gouty Attacks has Arrived in Florida

As cooler temperatures have arrived at Central Florida Foot & Ankle Specialists the first cases of 'Acute Gouty Attack' are arriving in my waiting room. These patients are easily identified by their obviously painful gait, red, hot and swollen joints of the foot. The patients will describe having had no trauma and going to bed without pain or symptoms only to awake in the wee hours of the morning in significant pain.
This is do to the cooler temperatures and lower Intra-joint pressures of the foot allowing the precipitation of uric acid crystals into the joint. White blood cells then attack these perceived foreign bodies in an attempt to dissolve them with their potent enzymes. Unfortunately, they are not up to the task and they die, thereby spreading their inflammation causing enzymes throughout the affected joint.
Most patients improve quickly with a taper down dosing of Indocin, but the reason for the attack, a high blood uric acid level, must be dealt with to prevent recurrence of symptoms and eventual joint destruction. This intervention usually takes the form of medication to improve the kidneys capacity to excrete uric acid more efficiently. Reducing the patients intake of foods that break down into purines (the precursor of uric acid) is also helpful. Avoiding shell fish, which I find to be most frequently the culprit, is recommended. Dr. Vic McNamara

Transient Compartment Syndrome of the Feet

I have a proficiency in lower extremity sports medicine and would like to make some suggestions for identifying the cause of foot pain, particularly as it relates to gym work-outs.First try to identify the specific anatomical part affected and if the pain radiates in any particular direction from that spot. You will probably need your trainers help with this. Next identify what makes it better, such as rest, and what aggravates the pain or causes its onset. These facts will help a professional give you an accurate diagnosis and treatment regime.Other than the maladies mentioned above, a very common problem that I see and describe as Transient Compartment Syndrome, (TCS), is very common in the gym. The symptoms are of an exquisite pain, sometimes gradually building, in the mid and forefoot. The onset is with lower extremity exercise that has been underway for several minutes. It is aggravated by continueing the work-out and often causes numbness in the forefoot and digits. It ultimately can cause a person to stop their work-out. The pain resolves upon stopping the activity and/or removing their shoe gear. Often, treadmills, stairmasters and elliptical machines are particularly aggravating due to their causing the feet to remain in a propulsive phase of gait too long. The first treatment that I try for this (TCS)is very simple and never fails when my diagnosis is correct. First, be certain that your shoes fit correctly. (You can check my blog for instructions on how to do that.) Then, re-lace your shoes so that you skip the cross over of laces at the middle two holes and the tongue tether and continue lacing again toward the ankle. This prevents the typically overbearing lacing pattern that most modern athletic shoes have from depriving the intrinsic muscles and nerves of the foot of their blood flow as they swell and engorge with exercise. I hope this information benefits you. Dr. McNamara

The Pathogenesis of Metatarsal Stress Fractures

As seen with Dancing with the Stars Tom Delay, stress fractures of the feet most frequently occur in the long bones called Metatarsals. They start with either an impact to the bone sufficient enough to bruise the bone or with small repetative flexing forces being placed on these long bones. The slang term "march fracture" evokes a good mental picture of a soldier marching longer distances than he is used to and thus causeing a contusion (bruise) to the bone. As mentioned this is just the start of the process.
The next phase is the increased activity of bone cells called osteoclasts. The bone structure is continually in a state of turn over and these osteoclasts are responsible for removing weak or damaged bone. For a period of approximately 3 weeks after the initial injury these osteoclasts eat away the damaged bone thus making it gradually weaker. It takes this 3 week period for the rebuilding cells, called osteoblasts, to show up on the scene to begin the re-building process. However, if the person afflicted continues to be active the osteoblasts can not get the job done and a hair-line crack develops in the bone and this is the stress fracture. Only adequate rest of the injured bone will alow it to heal