MRI of foot for Gout and foot pain

[Utubelite]

After almost 10 months of the injuring my toe and getting swollen foot, painful toe/foot and suspected toe fracture, and getting many confusing diagnosis ( Gout, Hallux Limitus, Bursitis, fracture, ligament tearing, gait change, mechanical fault etc.) from the doctors and podiatrist through a set of blood reports and multiple X-ray imaging, I was not able to still get back to normal foot. SUA has been around 4 for 6 months with 300 mg of Allopurinol and there had been no gout flare up since then. So, I finally decided to go for the MRI of the foot. I do not it helped or made it more confusing, but here is the report of the MRI–

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Findings –

There is hypertrophy of medial collateral ligament with mild irregularity along the medial aspect of the first metatarsal head. There is minimal bone marrow edema in this location. There is small degree of edema in the adjacent aspect of the base of first proximal phalanx.

The sesamoid bones show normal marrow signal intensity. There is minor degenerative change at the sesamoid- metatarsal articulation. The common extensor and flexor tendons appear normal.

There are no mass lesions present.

 

Impression –

Soft tissue hypertrophy and bony irregularity along the medial aspect of the first metatarsophalangeal joint. These findings could be result of degenerative joint disease. A gouty arthritis is less likely and would be of an early phase.

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I showed it to the podiatrist who has been treating me and the immediate reaction was – I told you you do not have the gout any more….as per the podiatrist, it is due to the toe injury and the swelling  / edema / tearing it caused which is still not fully gone….it is same podiatrist who diagnosed the fracture at first place and put me on the post op shoes.

ANYWAY, NOW QUESTION IS – WHAT ARE MY NEXT STEPS? CAN THIS REPORT BE CONCLUSIVE OF NO GOUT? THE PODIATRIST TELLS ME THAT I CAN CUT DOWN ON ALLOP AND STOP IT IN PHASED MANNER. I AM NOT WILLING TO DO SO UNLESS I AM CONVINCED. GOOD NEWS THOUGH IS THAT IT IS CONCLUSIVE OF NOT HAVING HALLUX LIMITUS AND OTHER SIMILAR PROBLEMS, WHICH IS A RELIEF AS HALLUX LIMITUS DOES NOT SEEM TO HAVE ANY REMEDY.

SO, I AM ASKING THE GURU'S HERE – ZIP2PLAY, KEITH, TREV, OTHERS….WHAT ARE YOUR OPINIONS? HELP ME ON MY NEXT STEPS. I HAVE NO PROBLEM WITH ALLOPURINOL AS OF NOW. THE BODY SEEMS TO TOLERATE IT WELL NOW  AND IT SEEMS TO HELP ME IN OTHER AREAS AS WELL –  LESS SNORING, BACKPAIN GONE( I USED TO HAVE CHRONIC BACKPAIN AND HAD TAKEN MORE THAN 50 PHYSIOTHERAPY SESSIONS…IT HAS DISAPPEARED MAGICALLY) ETC….

SHULD I FEEL  OR  OR  OR

[vegetarianGuy]

“ A gouty arthritis is less likely and would be of an early phase.”

That to me just means that he is guessing that it is not Gout and if it is Gout then it is at a very early stage so can't be visually pinned on scans yet. For your sake I hope you don't have anything but does not seem very consclusive to me.

“bony irregularity along the medial aspect of the first metatarsophalangeal joint. These findings could be result of degenerative joint disease.”

Again could be result of standard arthritis or Gouty one. Bottom line is that something seems to be causing joint wear. You coudl always come off AlloP and see what happens in next few years Or you can come off it drink lot of beer and eat tons of sea food to get  a quick answer.

Any chance of putting the scans (MRI/xray) up? Would love to look at them and compare with mine. I just have X-rays though. My next appointment with a good Rhumatologist is 1 month away so I might ask him for MRI scan too.

[trev]

Utube- If you can't get scans to show -can you put up a recent pic?

If you have arthritis then a lower SUA may well help, with or without Gout. No reason why you can't have both plus slow injury recovery.

I'm trying to get over a cracked bone in foot (I think) 4 weeks, and it is very like gout in catching the odd bang  and hurting. To plaster it would cause problems. I may have to get Xray yet.

It's fair to say that if gout was lurking seriously right now, it would have kicked in.

I'm still struggling with BP meds side effects, too.

Your med advice seems good & in depth and they can surely advise best- otherwise 'the middle way'?

Ease off AlloP to a low dose, watch diet/ drink and don't over stress yourself, or joints.

Monitor your SUA to not get near the 6+ on average, at least. 

[zip2play]

Utube,

Vegguy spelled out my feelings pretty well. Before tophaceous gout, an MRI, just like an X-ray, is almost useless. So, on the basis of hypertrophy (swelling), edema (swelling) you have been told your toe is swollen. Aren't doctors clever?

So the swelling is caused either by your injury that refuses to heal, by gout or by a combination of the two…or something all these doctors overlooked, something only Gregory House could ascertain like a rare virus prevalent only in Southern Nigeria.

So, cutting to the chase:

I HAVE NO PROBLEM WITH ALLOPURINOL AS OF NOW. THE BODY SEEMS TO TOLERATE IT WELL NOW  AND IT SEEMS TO HELP ME IN OTHER AREAS AS WELL –  LESS SNORING, BACKPAIN GONE( I USED TO HAVE CHRONIC BACKPAIN AND HAD TAKEN MORE THAN 50 PHYSIOTHERAPY SESSIONS…IT HAS DISAPPEARED MAGICALLY) ETC….

that implies to me that the wise course is to continue the allopurinol even if the only effects are the magical results you seem to be having with it. Who knows, maybe even your now gone backpain is gout.., buth there's no denying that gone is GONE.

Of course, if you MUST know for sure, then stop the allopurinol and for every meal for a month eat either delicious calves liver, or sardines washed down with some hearty lager. If you REALLY want to put the icing on the cake, take a thiazide diuretic. If that doesn't have you screaming in pain, then you know for sure you have “non-gout.”

I know…a tad extreme.

[Utubelite]

Hello vegguy, Trev and zip2play,

Thanks for the inputs. My podiatrist is very confident after this MRI as all the listed swelling and edema is exactly at the place where the toe fracture was suspected. So, the edema and hypertrophy confirms her theory of change in gait due to the trauma and difficult in walking and uneven distribution of load on the foot that I am experiencing.

The main point was to rule out – 1. Hallux Limitus  2. Damage to the cartilage  3. To find out if there was any fluid retention due to bursitis.

All above points have been ruled out now and at-least now I can say “Shut up ” to the other doctor who told me that I had Hallux Limitus.

Coming to point of Gout, I have no doubt that it played its role in the early days of injury though it does not mean that I may get it again and again…this only time will tell.

Remember, I had my first attack of Gout in Feb 1999. I tool Allop 200 for 3 months and rthen 100 for another 3 months and then stopped it. I did everything that is prohibited for gouties in the next 10 years without getting Gout till time I injured my toe.

Another interesting point is that though my first attack was in 1999, the MRI did not show any sign of Gout. That is surprising as I was expecting some signs of my earlier gout. Does it mean I did not have gout 10 years back and it was Virus from Southern Nigeria as suggested by zip2play

1. If everything goes fine, I may reduce Allop after few weeks and see how things go….

2. I do not want to go the route of diet control( sorry but that is ME, I would rather take medicine if my body can accept it and be free in my mind of what I eat and what not)….So, allop to continue for some time more…

3. Sea food and other organ meats do not mean anything to me as I do not eat them anyway…for me, meat is Chicken, Turkey and Lamb mostly….occasionally beef, seafood is not for me….But I am already trying few extremes and they seem to work fine…

4. I started wearing my narrow toe box shoes 4-5 weeks back( a big no for gouties), am wearing it for 15 hrs a day( 7 am till 10 pm) at-least 4 times a week to check the upper limits of torture to joint….I also drove car for 11 hrs with these narrow shoes ……And thank God, so far it did not cause any problem….And that gives me a lot of confidence…

Any suggestions on what more torture(non diet torture) I can give it to check for gout

[Keith Taylor (GoutPal Admin)]

Ligament hypertrophy (a special type of swelling where cells are enlarged) can be caused by many things, including mechanical stress, pseudogout and gout. In the cases of pseudogout or gout crystal deposits, the limited number of reported incidents are confirmed by delving into the joint, digging around for bits of stuff to analyze (they call it arthroscopy).

So with your history, Utubelite, not an entirely conclusive MRI. Given your allopurinol intake, it is unlikely that any further investigation into your joints will reveal any urate crystals.

As you have had 6 months without flare, it is perfectly in order to start to slowly reduce allopurinol to maintain uric acid level around 6mg/dL.

Looks like you are stuck with a less than perfect diagnosis, but allopurinol seems to have done the trick anyway.

[vegetarianGuy]

Utubelite I did not realize that you had a Gout attack 10+ years ago. Long before your current injury No wonder I was finding some comments strange on your other thread It all makes sense now.

Ok after visiting so many specialists I understand one thing very clearly. There are two issues always at play.

1- Which medical condition we ACTUALLY have.

2- What Doc or we THINK we might have.

Lot of the times 1 and 2 don't match So if you really had Gout attack before this injury then for me it's obvious that you should keep an eye on your SUA level for life.

[Utubelite]

I will post my Xrays in 1-2 days though I donot know how to post MRI as there are more than 100 images in the CD I got for the MRI.

Trev, I will also post a latest picture of my foot.

[zip2play]

I don't think you will be able to easily post an MRI.

I read a friend's last year and I cannot remember the form the images took. Perhaps if .JPEG you might be able to do it…but I seem to remember it more likely being a .pdf (adobe) format. Alas, I was more interested in helping her understand the pictures rather than the formatting. So I cannot be sure.

edit: More thinking and .pdf is becoming more certain.

They are fascinating though.

utube,

In your first post you mentioned “possiible fracture”…you mean they aren't even sure if there was  a fracture this far along in the game?????

[trev]

utube- You should be able to get a picture of the screen with Grabzilla10 whatever the format.

It can save as a JPG file (default is bmp) and then use Irfanview to shrink down the file size on the save options. Both these are free utilities btw.

Post them using the file upload here- to the right of the Omega sign above your reply post screen box.

[Utubelite]

Trev,

I will try you suggestions and see where it gets me in terms of posting the images.

zip2play,

When I said “suspected fracture”, it was initial 6 -8 weeks. In the first Xray taken 3-4 days after injury, it did not showup. When I was getting repeatdly painful and swollen foot, they did Xray again and it showed up second time. But it was always suspected that fracture and torn/overstretched ligament was causing a lot of problems. The one thing different in my case from general gout prospective was that even at the peak of the pain and swelling, I was able to fully bend my toe downward without any pain almost like a normal toe; it was upward movement that was painful. Besides, my pain was only when I was puting my foot down, there was no pain when I was resting and when there was no load on the foot….except for first 2-3 days when I felt severe burning sensations inside the bunion joint….didn't have them after that.

And that's what caused all this confusion of gout or no gout. The only reason gout was suspected as I told doctor about my history of a possible gout 10 years back ……and later on I thought and still believe it was gout as because SUA was high(9.2 measured after 8 weeks of injury), Colchicine helped me a lot though it was very low dosage, and Allopurinol made a lot of difference….though it could have been a healing process in itself over a period of time…..

May be I started Allopurinol a bit earlier but it is better than being late as otherwise high SUA could cause joint damage forever….I wish I could have started it within first week of the attack( like I did 10 years back and was back to normal in less than a week time), and it could have made recovery faster…who knows????….I believe it is the doctors who failed in correctly finding the cause and treating me correctly in the early stages that has made it linger on for such a long time and still continuing though at much lower magnitude….

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