Recently there have been several articles in Medical Journals  that support this position  concerning the   problems with this surgery.

In  Long-term results of neurectomy in the treatment of Morton’s neuroma: more than 10 years’ follow-up.  Kyung Tai Lee, M.D., and  others,  Foot Ankle Spec. 2011 Dec;4(6):349-53. doi: 10.1177/1938640011428510. Epub 2011 Dec 1

 the authors stated that they  reviewed 7 different studies between  1991-2008 and  their results regarding the surgery were slightly worst than other published reports done  regarding the Morton’s neuroma surgery. They went on to say complications of the surgery included numbness and  long lasting pain. And, this pain could cause footwear restriction and a poor results of the surgery in general.

They also stated regarding numbness 

“There was a great deal of numbness reported by patients, thus we assumed that continued numbness postoperatively  may have affected the results, and could be one of several considerations, in terms of post op results.“ 

Finally Lee and his group warned the doctors reading this article  to  ‘be aware of the long term prognosis” in regard to cutting out the Morton’s Neuroma and to make sure you tell your patient’s up front about the possible long term effects from this surgery.  The doctor better cover himself  and tell the patient  from the outset that most probably they will have some numbness  at the area of surgery, permanently,  and  may have some  problems wearing shoes  permanently.

In another study regarding Morton’s  Neuroma  Surgery entitled  

Long-term Evaluation of Interdigital Neuroma treated by Surgical Excision.  Womack JW, Richardson DR, Murphy GA, Richardson EG, Ishikawa SN. Foot Ankle Int. 2008 Jun;29(6):574-7. doi: 10.3113/FAI.2008.0574.

 The  authors stated  that  only 51%  of the patients felt they had a good outcome  in regard to cutting out of their  Morton’s Neuroma while 40% had poor results.

In another article regard excision of Morton’s Neuroma  entitled :

The Outcome of Morton’s Neurectomy in the Treatment of Metatarsalgia  Int Orthop. 2010 April; 34(4): 511–515. Published online 2009 May  30.  doi:  10.1007/s00264-009-0812-3

The  78 patients in the study felt that after an average of  4 ½ years, over ¾  of them  still complained of numbness in their toes. While 85% still  complained of some  pain going up to to the forefoot. About ½  stated that   this pain  was relieved by rubbing the foot. But  about ½  said they were completely satisfied with the procedure. The authors did admit  that many patients did have some on ongoing  discomfort in the area of the surgery; and 7 out of 10 still have some problems wearing shoes. The study also commented that n numbness in the web space postoperativly was very common.

From the above it is clear that the  classical Morton’s  Neuroma Excision Surgery does have many intrinsic problems The good news there are other surgery available for the treatment of painful Morton’s Neuroma, that is in fact much less traumatic to the patient, with a much shorter healing time, with much less pain and can be done in the doctors office. These 3 well established surgeries  have been around for many years and have been time tested  These surgeries are so well established that the U.S. Government in  their  Agency for Healthcare Research and Quality, has included the three surgeries below as part of  The National Guideline Clearinghouse as a acceptable treatment for Morton’s Neuroma. These guidelines were developed with the help of Academy of Ambulatory Foot and Ankle Surgery.  

1. Osteotomy of adjacent metatarsal(s) may be used for intermetatarsal neuroma in the event that the metatarsal is malpositioned or malformed, and that the purpose of the osteotomy is for treatment of both the neuroma and the pathological metatarsal as well.
2. Tendon lengthening/tenotomy/capsulotomy may be used for intermetatarsal neuroma in the event that the purposeof these procedures is both for treatment of the neuroma and the soft tissue pathology.
3. Severing of the inter metatarsal ligament. 

All three of the above are proved alternatives to the standard surgical  removal of the Morton’s Neuroma.  As of this  writing most neuromas are still being cut out, with all of the side effects (ie numbness, pain) associated with it.

 Please see my 12 minute video on neuroma if you would like to learn more about this painful problem

Plantar Fasciitis of the foot

The plantar fascia is the arch of the foot.  It is a thick band that runs along the bottom on the foot, from the heel to the ball of the foot. I  When it becomes injured, it becomes swollen resulting in the  medical problem known as  Plantar  Fasciitis .

            CLICK HERE TO READ DR. SCHULER NEW ARTICLE ON PLANTAR  FASCIITIS

The Human Foot by Dr. Dudley J. Morton, the most important book ever written about the Morton's Toe

Dr. Burton S. Schuler foot specialist , podiatrist , of Panama City Fl,  has published a new press release on the  Expertclick  wire service that states that Michael Phelps the greatest Olympian of all times has a  Morton’s Toe.     

Schuler pointed out that while watching  the broadcast of the semifinals of the breast stroke  NBC showed Phelps’s  feet and Schuler saw that  his  2nd toe was longer than the first toe. This is the  Morton’s Toe. In the press release Schuler points out why the Morton’s Toe could help Phelps in the pool.

 In 1927 and 1928  Dr. Dudley J. Morton of  Yale and  Columbia Medical School wrote two articles for the Journal of Bone and Joint Surgery, that stated that  problems with the 1st metatarsal bone, known as a Morton’s Toe could be the reason for most foot problems. Dr. Morton  then  wrote three separate books about the problem in 1935, 1938 and 1952. The most famous book being the Human Foot   published in 1935 by Columbia University Press.

Dr. Janet Travell, expert on the Morton's Toe and her patient President Kennedy, White House April 1961

  Dr. Janet Travell   President Kennedy’s and President Johnson’s White House physician,  was also a leading expert on the Morton’s Toe (Long Second Toe) and how it could cause pain almost anywhere in the body. She wrote and taught for four decades that a Morton’s Toe, could cause, aches and pains all over the body including back, hip, knee, leg foot and ankles problems”.

In her most important book Myofascial Pain and Dysfunction: the trigger point manual, written with Dr. David Simmons , she showed how a Morton’s Toe  (Long Second Toe) could be the real cause of not only the problems listed above but also of fibromyalgia, sleep disturbances, and TMJ. . She felt it was so important to understand how the Morton’s Toe could cause pain that at the age of 89, she made a video tape to teach other physician about it and how treat it.   

About :  Dr. Burton S. Schuler  is a leading authority on the life of Dr. Dudley  J. Morton,   and  Morton’s Toe,  Long Second Toe and it associated problems. He is the author of the newly published book about The Morton’s Toe, Why You Really Hurt: It All Starts In the Foot. The book is published by the La Luz Press, Inc and is disturbed national by the Cardinal Publishing Group.  Why You Really Hurt: It All Starts In The Foot, is the story of how one bone in your foot could be the real reason for pains thru out your whole body. It is important because it offer the public new information about why millions of people suffer everyday with aches and pains, and offers new hope to get rid of problems they believed they would have to live with forever. It literally can be the “medical missing link”

President Bill Clinton and Dr. Burton S. Schuler 1996

  Dr. Schuler, graduated from the N. Y. College of Podiatric Medicine in 1975 at the age of twenty-four, and has been in private practice ever since. In 1982, he published his first book, The Agony of De-Feet: A Podiatrist Guide to Foot Care. During his thirty-seven year professional career, he has written for Collier’s Encyclopedia and various podiatric journals and publications. He has been interviewed by The New York Times, First in Women, and other publications. Dr. Schuler has appeared on hundreds of radio and television programs both here and aboard. He is a Diplomate of the American Academy of Pain Management,  National Board of Podiatric Examiners.  and the American Board of Wound Management. His professional and civic accomplishments have earned his inclusion in the 1999-2002 Who’s Who in America (Marquis).

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Paraffin bath, simply heating device to help your sore feet and heels

In my previous article entitled Sore Feet  Best Treated by Heat not Ice says Podiatrist  I explained how heat works and why it is better than ice, for foot care for   healing of sore, painful, hurting feet and heels . 

Here you some easy things  you can do at home to heat your feet so that that you can decrease  your soreness and pain.  Most of this material was taken from Chapter 9 my book Why You Really Hurt: It All Starts In The Foot.

 HEATING PADS, PARAFFIN BATHS AND SOAKS

I have found that most people at home can use heating pads, paraffin baths, or soaks. Regardless of which ones you use the aim is to decrease your pain by increasing blood flow to the damaged areas of your feet. This is the key to your healing. The trick is to use them on a daily bases, several times a day if you can. 

Heating Pads

Common sense demands that you do not to make the heating pad too hot. It you have any difficulties in feeling the proper temperature due to any type of problem(s), you may have to use your elbow to feel the warmth of the pad or get someone to check it for you.  Moreover, if you have, any doubts get the permission of your own physician before you start.  Diabetics are injured daily from heating pads. See the federal precautions below

Paraffin Baths   see photo above

One of my favorite home heat treatments is paraffin bath. It is one of the most effective methods of applying deep heat to relieve pain and stiffness. A paraffin bath is a plastic tub that you melt wax in. You dip your foot, into the tub of wax, applying several coats of wax up to the level of the ankle. Then you wrap your feet up in towels. The hot wax then sends great amounts of blood down to your feet. It is also great for painful hands. A good one costs about $150.00, but I saw one last year at Wal-Mart for about $50.00. With regular use, it can help remove the chronic pain, swelling, soreness, aching, and throbbing from your feet and ankles. As above, before using a paraffin bath make sure there is no medical reason why you can’t. 

Soaks

Since the time that man has been hanging out in caves, , we have been sticking our bodies in warm water to feel better. Be it a pan of water, a warm tub, or trip to your spa; soaking parts of our body has always been  a neat thing to do. From the standpoint of our feet, soaking will flush your feet by bring blood to it. As I said previous, this flushing will heal our feet, by washing away damaged tissues that have collected over a period. By getting this inflammation  out of the injured areas in your feet, you will start to feel better.

 DO NOT make the water very hot – warm is just fine. Do not waste any money by putting anything in the water; unless you want to. What is important that you soak it several times a day for about twenty minutes, if you can,  ASSUMING THERE IS NO CONTRINDICATIONS TO DO SO.

I am so concerned with this that please find reprinted below the Food and Drugs Administration booklet on the proper use of heating devices.

PLEASE READ BEFORE USING ANY HEATING DEVICE INCLUDING THE HEATING PAD OR PARRFINBATH.

HEATING DEVICES

HOW TO AVOID BURNS

A PATIENT WITH ARTHRITIS SUFFERED A SECOND DEGREE BURN to the hip after receiving treatment with a heating pad for pain. Set at low, the heating pad was left on for less than 20 minutes with the patient lying on top of the pad. Later testing showed that the pad was working properly and met the manufacturer’s specifications. What went wrong? Therapeutic heating devices, such as heating pads, hot packs, and hot water bottles, although generally safe, can cause burns. Most burns result from improper use or use with inappropriate patients, such as infants and elderly patients. The severity of the burn is influenced by factors such as heat intensity, length of application, and the patient’s age, medical history, and ability to sense pain. What precautions can you take?

Follow these do’s and don’ts to keep your patient safe when using heating devices:

DO inspect the device before each use to ensure it’s in proper condition.

DO read directions and contraindications for use.

DO use a protective cover.

DO place the pad or pack on top of not underneath the patient.

DO assess skin integrity frequently and adjust the therapy interval according to the patient’s skin tolerance – no longer than 15 to 20 minutes.

DON’T use the device on someone who’s sleeping or unconscious, an infant, or a patient with altered mental status or decreased skin sensation (such as people with diabetes or compromised skin circulation).

DON’T use pins to fasten the device in place.

DON’T use with ointments or salve preparations containing heat-producing ingredients.

DON’T use electrical heating devices in an oxygen-enriched environment or near oxygen-emitting equipment.

Most of the above is common sense but it was important that you read it.

Over the years I have helped many patients by having them use  heat at home.  Give it a try, but just be  careful. 

Dr. Burton S. Schuler, Podiatrist, Foot Doctor, Panama City Fl

About the Author:  Dr. Burton S. Schuler foot doctor, foot specialist, podiatrist  of Panama City, Fl and the director of the Ambulatory Foot Clinics Podiatric Pain Management Center  and is a leading authority on the Morton’s Toe,  Long Second Toe and it associated problems. He is the author of   Why You Really Hurt: It All Starts In The Foot the story of the Morton’s Toe  Dr. Schuler, graduated from the N. Y. College of Podiatric Medicine in 1975 at the age of twenty-four, and has been in private practice ever since. In 1982, he published his first book, The Agony of De-Feet: A Podiatrist Guide to Foot Care. During his thirty-seven year professional career, he has written for Collier’s Encyclopedia and various podiatric journals and publications. He has been interviewed by The New York Times, First in Women, and other publications. Dr. Schuler has appeared on hundreds of radio and television programs both here and aboard. He is a Diplomate of the American Academy of Pain Management,  the National Board of Podiatric Examiners and the American Board of Wound Management. His professional and civic accomplishments have earned his inclusion in the 1999-2002 Who’s Who in America (Marquis). 

Dr. Burton S. Schuler a podiatrist, foot care specialist of  Panama City Fl,     has produced a series of five articles and one vide. about Gout that appears on his  FootCare4U.com  website   Gout is a painful arthritic condition caused by an excess of uric acid in the blood.  This final article of the series is about nutritional and natural treatment that the reader might want to consider when they are starting a treatment plan for gout.  Dr. Schuler is not advocating the use of any of the below but is presenting them to complement his other articles and his video on gout. He is directing the readers to further investigate them and to consultation with their doctor to use them or not.

Nutrition:

Improved nutrition awareness is one basic way to prevent and treat gout.  This dictates that gout sufferers’ do not eat anything that will further increase uric acid in their system  The nutritional treatment of gout includes avoiding foods and beverages such as alcohol (especially beer), coffee, red meat, all organ meats, meat gravies and broths, sweetbreads, seafood (especially anchovies, mussels, herring, and sardines), spinach, asparagus, mushrooms, beans, lentils, and peas. 

On the other hand foods, such as unsweetened cherries, are good for treating gout: “The equivalent of 20 tart cherries inhibits enzymes called cyclooxygenase-1 and -2, which are the targets of anti-inflammatory drugs” In general cherries have also shown promise of being useful in decreasing joint pain in general. This is due to a compound known as anthocyanins that give tart cherries their color are likely responsible for their anti-inflammatory, pain-killing effect.

 Vitamins:

Certain vitamin supplements can also lead to high uric acid levels and then cause a gouty attack. These include excessive niacin (vitamin B3), Vitamin C, and salicylates (the active component of aspirin)   Two vitamin supplements acknowledged in the successful natural treatment for gout, and should ideally be taken together daily between meals are 

1. 200-400 mg of Quercetin (which inhibits uric acid production) and 

2. 200-400 mg of Bromelain that Bromelain contains proteolytic enzymes that help to break down proteins into smaller units. 

 Proteolytic enzymes work as anti-inflammatory agents in the body and are therefore beneficial for reducing the inflammation that is associated with gout. Bromelain may also increase blood flow to the inflamed area, and this can hasten and enhance healing during flare-ups Finally, Bromelain may block the production of kinins, which are substances that are thought to contribute to the swelling, inflammation and pain of gout.

 Good Food for Gout

What can you eat that is beneficial for treating gout?  Unsweetened cherries can be consumed whole or as a juice (see above). Also, milk, non-fermented milk products, cottage cheese, mozzarella, whey protein, egg whites, and pulp-free fruit juices are all very safe and do not exacerbate gout symptoms.  But perhaps one of the most important remedies for treating gout is also one of the most readily available: water.

 Water:

 The National Institute of Arthritis and Musculoskeletal and Skin Diseases  (a government agency)  suggest one of the easiest ways to treat a gout attack at home is by increasing your water intake. Many people drink coffee, soda, and energy drinks which do little to replenish necessary bodily fluids, and they may, in fact, contribute to overall dehydration.  Drinking more non-caffeinated fluids, especially water, will increase your urine output.  Increased urine out can help flush excess uric acid out of the body, thus eliminating the essential factor that causes gout: excessive uric acid levels. At minimum, it is suggested to drink 64 ounces of water a day or more for general health, and especially if you suffer from any number of painful conditions, such as gout.

 Apple Cider:

In addition to increasing your water take, supplementing apple cider vinegar in your diet can also be a positive remedy for treating gout.  Apple cider vinegar is a known natural treatment for many conditions.  In Alkalize or Die, Theodore A. Baroody argues that apple cider vinegar can help shift the scale from a pH balance that’s acidic–causing gout–toward alkalinity.  “Baroody says drinking apple cider vinegar can break up uric acid crystals and prevent them from reforming in the joints. If you use apple cider vinegar to treat gout, you may notice an increase in symptoms, at least initially…this occurs because the uric acid causes some inflammation as the crystals dissolve, and these symptoms should subside within a few weeks (

 Finally, the benefits of epsom salt soaks can not be overlooked.   In a new 2012 article Epsom salts was presented as a possible treatment for gout. It is made from magnesium and sulfate, which are both very beneficial minerals used in natural Magnesium helps relieve muscle inflammation and pain: it also regulates electrolytes while improving nerve functioning.  Sulfates aid in the flushing of bodily toxins and help form joint proteins that ameliorate painful arthritic conditions such as gout.

 Whether you try one or all of these natural/ home remedies for treating gout, the above suggestions, in consultation with your physician, should get you started on your path to recovery. Of course do not over look all of the medications availably for gout, but again talk to your physician first. 

Dr. Burton S. Schuler is a foot doctor, foot specialist (Podiatrist), of Panama City, Fl and the director of the Ambulatory Foot Clinics Podiatric Pain Management Center. He is also the author of the new book Why You Really Hurt: It All Starts In The Foot 

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Painful inflamed big toe joint caused by Gout

In his previous You Tube Video and article about gout, Dr. Burton S. Schuler stated that gout is a form of painful arthritis caused by high uric acid levels in the blood, which affects joints, especially the big toe joint of the feet.  Schuler also says  that the pain in the joint occurs  when it becomes  inflamed with “gouty crystals”  that settle into  joint spaces. (See Merck Manual.) .  Since high uric acid levels cause this painful condition, the treatment goal is to block or lower uric acid levels through nutritional or medication.  The aim of this article is to discuss the types of medication used for treating gout.  Dr. Schuler’s next article will be about nutritional treatments for gout.

Colchicines has already been written about in a separate article by Dr Schuler.  So the other drugs for gout will be discussed here. 

 Allopurinol (Zyloprim): This drug is used millions of times aday  for the long term treatment of gout. According to the National Institute of Health, Allopurinol is in a class of medications called xanthine oxidase inhibitors, which help reduce the production of uric acid in the body It works by inhibiting the synthesis of uric acid and it is linked to vascular inflammation, and liver toxicity. These side effects require periodic liver enzyme and renal function tests and complete blood counts for patients on Allopurinol. . Allopurinol is also said to cause gastrointestinal intolerance, such as nausea and diarrhea, and rash develops in about 2% of its users.  Also, Allopurinol hypersensitivity syndrome which is a serve allergic reaction remains a major concern among physicians because it can be life threatening.  Allopurinol is also sometimes used to treat seizures, pain caused by pancreas disease, and certain infections. It is also sometimes used to improve survival after bypass surgery, to reduce ulcer relapses, and to prevent rejection of kidney transplants. Odd Facts: It can take many weeks/months before you feel better from taking this drug.  .  During that time your physician may start you on colchicine to prevent you from having a gouty attacks. 

Newer Drugs:

Uloric: According to the drug’s website, this relatively new and more effective drug is the first FDA approved for gout in forty years.  The drug’s goal is to stop the body’s transformation of purines into uric acid.  When compared with Allopurinol in clinical studies, patients taking 40mg of Uloric reached healthy uric acid levels as those on Allopurinol, and “Up to twice as many patients on Uloric 80 mg reached a healthy uric acid level as those on Allopurinol”   They also claim that when   again compared to Allopurinol, more patients’ with mild to moderate kidney problems reached healthier uric acid levels with Uloric. Also, Uloric can be said to be more convenient than Allopurinol since it is taken only once a day, almost anytime, while Allopurinol’s equivalent effective dosage requires taking a pill four times a day, with recommended dosages imbibed after meals for optimal effectiveness. 

 Lesinurad:   But for some gout sufferers, the side effects of both Allopurinol and Uloric are too severe for comfort.  In June, 2012, Andrea Biosciences, Inc. announced a preliminary study on a new drug, Lesinurad, intended for gout patients who exhibit intolerance to xanthine oxidase inhibitors like Allopurinol or Uloric According to the Lesinurad clinical trial announcement, 20% of patients report side effects with Allopurinol and 5% discontinue Allopurinol due to these side effects

Febuxostat: Is another new drug   in clinical trials that has shown a similar profile to Allopurinol. Liver function abnormalities, nausea, arthralgia and rash were the most commonly reported problems” (http://clinicaltrials.gov/ct2/show/NCT01508702).    

 Other Drugs: Research to develop medicines that treat gout symptoms is ongoing, and scientists are also studying which medicines most safely lower uric acid levels.  For example, a drug called Cozaar (Losartan) is used to treat high blood pressure, and it also lowers uric acid levels.  Fenofibrate is used to control certain fats in the blood, and it may increase the kidney’s ability to eliminate uric acid (http://www.medicinenet.com/fenofibrate-oral/article.htm).  A new medicine, a Urate oxidase; that  may change uric acid into an absorbable molecule is now under investigation  There is also  a new class of  drugs, called  Y-700 medicines  that decreases the amount of uric acid the body makes, that  are also being evaluated.

Dr. Burton S. Schuler is a foot doctor, foot care specialist (Podiatrist), of Panama City, Fl and the director of the Ambulatory Foot Clinics Podiatric Pain Management Center.He treats patients with gout on a regular basis.  He is also the author of the new book Why You Really Hurt: It All Starts In The Foot 

Dr. Burton S. Schuler, Podiatrist, Panama City Fl

 In my 2009 book Why You Really Hurt: It All Starts In The Foot I explain why  I love using heat for the treatment of chronically  sore feet  and heel problems. Some doctors may disagree with me, and say ice is better, but after being a podiatrist for  37 years and for treating  about 25,000 patients during that time, I absolutely believe that heat is the way to go for helping  sore, painful, aching feet . Ice is okay right after an injury, like when you twist your ankle. But besides that, heat is the best way to go, for you to mend your own damaged feet.

Why Heat? The most oblivious reason is the wonderful soothing effect heat has. It will just make you feel better. This is for the simple reason that heat will increase the blood flowing into the foot . When more blood is brought into the foot, it will start to remove all of the damaged tissues that has buildup over a period of years. This buildup was due to the constant abuses that your feet were exposed to. Once you start to flush, or push out this stuff, the redness, swelling, soreness,  throbbing and aching in your feet and other parts of your body will start to go away.

How It Works: The best way I can explain this is to tell you about the puddle verse the water hose. If you have a large puddle of water that was caused by a heavy rain in front of your house, you might want to get rid of it. So how do you do it? Well, you can take a bucket and with several trips get rid of it that way. Or you can take a broom and sweep it away. Or, you can take your hose and with using the sprayer push more water into puddle making it wash away. That is exactly what you are doing with soaks, heating pads, and paraffin bath (see below). You are washing away, and pushing out, the abnormal buildup of inflammation due to injuries, by adding more circulation to the area. Podiatrists have under stood this concept for years, and often will give a nerve block in the foot in order to increase the circulation. When certain nerves in the foot are numbed or blocked , it has the effect of causing the blood vessels to open up wider, and bring more down blood into the foot. This increase blood flow decreases pain and inflammation by washing away all of the rubbish that has buildup over time, in your foot. Basically this is the same concept as the hose and the puddle. And, that is what you will be doing when you use heat to bring more blood into your feet. Ice is doing the exact opposite by closing down the blood vessels and not letting blood in. People like ice because it is freezing and numbing  the area which I feel is the worst thing you can do. Again the aim of the treatment is to bring more blood into the area to wash away the   inflammation that is build up. 

In my next article I will write about specific things you can do at home to heat your feet.

Chemical Structure of Colchicine

 This is the first in a series of articles   I will write about the drugs  for treating  gout.

Colichicine is the first drug used in the treatment of a acute gouty attack Gout is a metabolic condition caused by an elevation in uric acid in the bloodstream. This increase can lead to a abnormal deposit of painful  urate crystals in and around joints, and in  soft tissue  structures, Gout is the most common form of crystalline arthritis.

A gouty attack  is incredible painful.  It is not just painful but among the most painful conditions you can get. It occurs most commonly in the big toe joint with the foot becoming red hot and swollen, with limitation of motion.  The classic time for an attack of gout is early morning or late night. The underlying cause for this is due to reabsorption of excess joint fluid at night,  that results in the increase deposit of the very painful  uric acid crystals into the joint. You see if there is more fluid in the joint the urate crystal are in a liquid state and are less likely to  become painful because as a liquid they are floating around in the joint and not cutting into the joint  . Most patients are men  between the ages of 30-60, most commonly around 50.

History. Colchicine is from the plant Colchicum autumnale that is found in the Colchis area of Asia.  Colchicine was introduced for the therapy of acute gout by Anton von Storck in 1763,. Benjamin Franklin, had gout, and was  reputed to have introduced colchicine as a  therapy in the United States. Colchicine is a one of a kind anti-inflammatory drug, It’s single real use is for the treatment and prevention of gout and  gouty arthritis  Historically gout was divided into primary and secondary phases.. Colchicine is used in the first phase which is the acute, crushing pain when gout first hits.   It gives dramatic relief from this crushing pain  Four drugs of proven value are available and commonly used during the first phase, : col­chicine, phenylbutazone, indomethacin, and corticosteroids (or ACTH).  The second phase of the treatment of gout  is the long term management to prevent gouty attacks from coming  back which I will write about  in the future.

 The aim of Colchicine therapy is to reduce the severity of the gouty pain and quickly terminate the acute inflammatory process associated with it. The patient should also rest as much as possible during this attack and  immobilized and protected the effected area.  

Colchicine is also unique in that if the diagnosis is in doubt, a clear-cut response to colchicine is still widely used as confirmatory evidence of gout.

The response to this drug is often dra­matic. Joint pains and swelling begin to subside approximately twelve hours after the institution of therapy and in most instances pain is completely relieved in from one to two days. Over 95 per cent of acute attacks are materially benefited by a single course of colchicine. The response to colchicine is often disappoint­ing if the drug is started several days after the onset of acute symptoms; relief is usually prompt if therapy is begun at the very onset of the attack. Should no benefit occur, a second course can be given after an interval of three days; repetition sooner might precipitate marked gastrointestinal symptoms.

SIDE EFFECTS: There are many side effects The most common side effects of colchicine are nausea, vomiting, abdominal pain,  diarrhea difficulty breathing; swelling of your face, lips, tongue, or throat.. Colchicine also may cause hair loss, weakness, and nerve irritation. All patients taking colchicine long-term require monitoring of their blood counts because it can cause  damage to their  bone marrow causing severe anemia, low white blood counts, and low platelets. Reduced white blood cell counts may increase the risk of infections. Colchicine also may cause muscle pain (myopathy) or severe muscle breakdown (rhabdomyolysis). Patients with renal or liver dysfunction or taking some other drugs (for example, simvastatin and other statins, gemfibrozil, fenofibrate), which also affect muscle tissue, are at a higher risk of developing rhabdomyolysis. 

Grapefruit and grapefruit juice may interact with colchicine and lead to potentially dangerous effects; be sure to ask your doctor about this. 

DRUG INTERACTION:  Colchicine can interact with many drugs. . Tell your doctor about all other medications you use, especially: cholesterol-lowering medicines such as atorvastatin (Lipitor), fenofibrate (Antara, Lipofen, TriCor), digoxin (Lanoxin, digitalis);gemfibrozil (Lopid), simvastatin (Zocor), lovastatin (Mevacor), pravastatin (Pravachol),  and antibotices such as erythromycin 

For more information about gout here is a video by Dr. Burton S. Schuler

 Dr. Burton S. Schuler is a foot doctor, foot specialist (Podiatrist), of Panama City, Fl and the director of the Ambulatory Foot Clinics Podiatric Pain Management Center. He is also the author of the new book Why You Really Hurt: It All Starts In The Foot 

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The 5^th metatarsal bone is a long bone in the foot that connects the rearfoot to the 5^th toe. It is one of five metatarsal bones in the foot, each corresponding to a digit. Fractures of the 5^th metatarsal base (the end of the bone closest to the ankle) are commonly associated with classic ankle injuries where the foot turns inward.

There is a muscle that passes along the outside of the ankle and inserts into the 5^th metatarsal bone at its base called the peroneus brevis (PB). With an ankle sprain or injury where the foot turns inward, the PB contracts and pulls on the 5^th metatarsal base, sometimes so strong that it avulses, or pulls a piece of bone away from the rest of the metatarsal bone. Therefore, when you twist your ankle and have not suffered an ankle fracture, you may not be completely ‘home-free;’

You should be suspicious of a 5^th metatarsal base fracture any time that you are suspicious of an ankle injury. However, residual pain along the outside of the foot along the 5^th metatarsal bone is a good indicator of injury to that area. Try sliding your finger along the outside border of your foot from your 5^th toe back towards your heel.Along the way you should feel a “bump” which is the landmark of your 5^th metatarsal base. Pain in that are can be indicative of a fracture, as that is the most likely place where the PB would have pulled off a piece of bone. Be particularly suspicious if the pain in that area has not improved several days after your ‘ankle twisting incident.’

Fractures of the 5^th metatarsal base are particularly tricky to treat because the blood supply to that area of the bone is delicate. In the area of such fractures, two blood supplies are coming together, and disruption of their connection via fracture can permanently hinder the healing process, as blood supply is imperative to bone healing.Keeping that in mind, early detection of a 5^th metatarsal base fracture is important so that immobilization can be initiated as soon as possible. The goal of immobilization is to decrease motion at the site of the fracture to encourage healing making the delicate blood supply less of a factor!

There are several ways in which immobilization of the fracture site can be initiated and the choice depends on the severity of the fracture. If the fracture is well aligned and shows no gapping between fragments, conservative treatment with immobilization in a short leg cast is indicated. If the fracture is displaced and there is significant gapping between the fragments, the fracture is unlikely to heel unless the fragments are brought back closer together. In this case, surgery may be indicated to place a pin or screw across the fracture site and immobilize the fragment with the “hardware.” A short leg case is still indicated to ensure that the patient remains non-weightbearing and minimizes the risk on non-healing.

In either scenario, 4-6 weeks in a cast should be expected so that the bone has time to heal. Once healing is noted and pain in the area of the fracture is severely decreased or absent, transition into a walking cast and eventually back into a comfortable supportive sneaker can be allowed.

Next time you twist your ankle, don’t be fooled into thinking is just an ankle injury, unless you’ve been cleared by your Podiatrist and no 5^thmetatarsal base fracture has been suffered!

Painful Corn of the tip of the 3rd toe

One of the most common question I always get asked is “ what is a corn “
A corn is a thickening of the skin that occurs due to excess pressure and or friction on the top of a toe. As this abnormal process continues the toe will get irritated and a red area appears on the toe. As the irritation continues, more blood will come into the toe which increases the rate of the growth of the skin. This increase growth of the skin is abnormal At this point mother nature will attempt to put down a shock absorber over the toe to protect it. This is called corn
A complication of this irritation is that a bursitis which is a sac of fluid forms underneath the deepest part of the corn. This sac is also nature’s way of attempting to protect the underlying insulate bone and skin body tissues. As this inflamed bursa continues to become more irritated it will put pressure on a small sensory nerve branch. This will cause a dull, throbbing ache when it’s first starts, or a sharp exquisite pain at its worst. When this occurs shoe wearing becomes very difficult
If the corn becomes chronic and the pressure continues to be exerted on it, not only will the underlying bone becomes inflamed but the body will respond by producing new body.

Hammer toes are common causes of corns

A hammertoe, deformity is also a common cause of corns to occur due to a foot imbalance of the muscles

Start of a small corn 5th toe (see discoloration)

Soft Corns

 A soft corn is usually found between 2 toes, normally the  fourth and fifth toes. It is formed from the friction of these two toes rubbing  against one another for a period of time. This abnormal friction makes mother nature produce a corn on one or both of the toes, The reason it is called soft is because of the moisture buildup in between the toes that makes it wet.  The treatment is the same as the corn on the top of the toes.

This is a soft corn of the 4th toe

 Treatment

Cutting or trimming of the top layer of a corn is the most common treatment Depending on the severity of the corn it will only give you temporary relief anywhere from 2 to 6 weeks
For more involved corns, a minor office surgical procedure can be performed in your podiatrist’s office without any undue discomfort, either dur¬ing the procedure or afterwards. These minor incisions heal quickly, permitting the patient to return to normal foot gear almost at once, and without losing any time at work.