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Gout or Sesamoiditis?

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January 25th, 2008
Hi All. I hope you have some good advice for me.

Last year I ran in a couple of charity 10 kilometre runs. I'm not especially sporty at all, but it seemed a good thing to do. The second of these was in early October, and I left my training a little late, so went at it a little over enthusiastically from around mid-september. This run was due to take place on a hilly course, so I trained on the slopes of the park near my home.

During training, I began to feel a dull ache in my right big toe and ball of foot. Often, after running I would feel an urge to 'scrunch' my toes to relieve this nagging toothache-like sensation.

I managed to complete the run, but felt I was running slightly on the outside of the affected foot. This altered gait found its way into my walk and soon I noticed muscular stress in the right leg caused by this barely perceptible but unusual way of walking.

Soon, putting weight on the big toe, bending it up sharply or pressing into the side of the ball of the foot would cause tenderness - not acute but moderately tender.

I decided to see my doctor, explained all this, and his first words were "Have you had gout before?" like it was a foregone conclusion. None of the training stuff seemed to interest him.

He diagnosed anti-inflammatories and I had a blood test for uric acid level. This came back 'slightly raised'. (THe nurse quoted a figure of 420 when the normal band is between 200 and 400, apparently).

In the meantime, I had found reference to Sesamoiditis on the web which seemed to match all my symptoms and possible causes. I brought this up with my doctor but he showed zero interest (I understand it could be annoying for a doctor to listen to a patient's amateur web-based diagnostic theories, but I wished he'd at least have listened...)

SO. Slightly raised uric acid. Mild big toe and ball of foot pain, beginning during uphill running training and persisting for 4 months+ with no peaks and nothing remotely excruciating.

Does this sound like gout to anyone?
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JYY2
replied January 26th, 2008
Experienced User
May I ask: are you treating it with any medication? If so, how long you have been on the med and what's the response?
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Toeache
replied January 27th, 2008
Hi JYY2

My doc prescribed Diclofenac when I first presented. He didn't actually tell me when to take it - or how much. I tended to take one 50ml tablet with breakfast for a while and then stopped when the toe seemed to return to near-normality (I wasn't sure if I was meant to hang on to the meds in preparation for a REAL gout attack).

Anyway, the problem never really went away. Being on my feet for long periods or bending the toe upwards with weight on it seems to bring the problem back.

I've also tried using orthotic insoles to take weight off the ball of the foot, and strapping the big toe to the next toe to prevent it bending too much. These measures both seem to help when the problem is at its worst (although, I stress again, it's never been too bad) but I worry that they may contribute to my change of gait, which I think may have caused other aches and stresses in the whole leg.

A fairly important new point to mention is I'm pretty sure i've got some small deposits in the helix of my right ear. (Not the kind of thing I'd ever have noticed until I saw mention of this on another gout-related website.) This makes it look like gout, I guess? Is there such a thing as 'mild gout' or mild, prolonged gout attacks?

I guess another possibility is that by sheer coincidence I have aggravated my sesamoids at the same time as gout symptoms were beginning to appear.
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JYY2
replied January 28th, 2008
Experienced User
Hi, Toeache,

Thanks for the reply. It could be the low-grade gout attack caused by the over-exercise or injury from running; and, you did not take enough Diclofenac to lick the problem.

I would go back to the GP (and a podiatrist and a rheumatologist if necessary) for:

1) Colchicine to take by mouth for gout.-- Colchicine is more specific in treating gout. If it works, that means most likely you have gout. It may cause diarrhea. So ask for some Lomotil to take by mouth in case the diarrhea is bad.

2) An X-ray to rule out micro-fracture of the bones, including sesamoid bones of course.

3) A shot of cortisone in muscle. The symptoms may disappear quickly.-- This is a strong medicine. The doctors may not want to give it to you.

4) Tests to examine the the joint fluid and the deposits in the helix of your ear, for monosodium urate crystals. They may think the symptoms are so obvious that such tests are unnecessary.

Good luck.
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Toeache
replied January 28th, 2008
Thanks JYY2, you're a star.
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gallego1968
replied January 31st, 2008
I was told when taking Colchicine if you vomit or get diarrhea you must stop taking it straight away.
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painfree
replied January 31st, 2008
Experienced User
Colchicine is used as a gout-specific pain reliever. It can be toxic, even fatal in a small number of cases. According to my former rheumie, diarrhea is almost always the first sign of its toxicity, so its use should be stopped if diarrhea develops.
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redngreedy
replied January 31st, 2008
How bad should we let the diarrhea get before we stop? Mine isn't that big of a deal, just a very loose stool maybe 2-3 times a day.
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runner24601
replied May 19th, 2008
see a specialist
My experience is very similar to the original poster's - particularly the bit about my GP being convinced from the start that I had gout (despite my lack of family history, and the non-gouty pattern of symptoms). Then this morning, on my own initiative, I saw a podiatrist, who listened to my entire story and said "oh, that's definitely sesamoiditis."

Among the general population, gout is a much more common diagnosis, so that's what GPs think of. Try to see a foot doctor, if you can. Good luck.
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