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This is my first post and I found this place thanks to Google. I really could do with some advice. Thanks for your valuable time and patience.

I am 36 years old in good overall health, 63kgs/138lbs weight approx. 172cms/5' 8" tall. Eat a very healthy diet and a vegetarian for last 8-9 years. I do moderate level of regular training in the gym. My left toe joint area (1st metatarsophalangeal ) started hurting for no apparent reason 10 months ago. It's not extreme pain but it is constant and always there 24/7 fo rlast 10 months.

If 10 is maximum pain possible then mine is between 4 and 6. Similar pain but on a lower level say between 3 and 6 started few months later on my right toe joint too. So the pain has been there constantly for last 10 months. If I walk a lot then pain [B][I]may[/I][/B] increase slightly sometimes and other times not increase. Pain does not increase or decrease at night or in the morning or with increase or decrease of temperature.

I will tell you my story and see what you guys think. I am at my wits end. Please bear with me.....

[B]April 2009- [/B]I went to my family doctor who sent me to get my left toe x-rayed. Doc at the X-ray place sent the following comment with the X-ray to my family doctor-
Quote:
"Inconspicuous bony structures without osteolysis or sclerotic changes. No degeneration in the Big metatarsophalangeal joints. Appears normal to the sesamoid. Normal position. No soft tissue swelling"

Family Doc said everything is ok and it must have been a strain. Will clear up in a month or so. I enquired if it could be early signs of crystal formation due to Gout as my father has Gout and on my mum's side my granddad had Gout too.
Doc said that it does not look like Gout as Gout is lot more painful with redness and clear swelling. He said that I had around 10% swelling only. Also I can rub my toe without pain something which is impossible for Gout attack patients.
[B]
June 2009-[/B] The pain never cleared up. Did not increase nor did it decrease but was always there constantly and driving me nuts. I went back to the family doc and he had no answers any more. He thought maybe there could be Gout related crystal formation causing this pain. So he referred me to Hospital rheumatology department. Appointment date came for August as my case was not emergency.

[B]July 2009-[/B] Tired of waiting for my appointment date I privately made appointment with MrRheumatologist A. He said that I don't have Gout. He remarked that my feet are wide in the front and maybe slightly flat. He said that he could not do anything more for me and I could come back few months later if it does not go away. He said that he is sure that I don't have Gout.

[B]August 2009-[/B] My appointment date with Rheumatology department at the hospital finally came. MrRheumatologist B checked me and said that I definitely don't have Gout. As Gout attacks don't last this long unless it is chronic Gout which I definitely don't have. As you can't jump from no Gout straight to chronic Gout. He said my above normal blood uric acid readings are nothing to be worried about. They would be relevant if this had been a Gout attack which it isn't. He also remarked that my feet were wide and the gap between the toe and the next finger was large and maybe causing stress on the toe joint. He looked at my X-ray and said everything looks normal with the bones. He called his superior MrRheumatologist C for second opinion and he agreed with his diagnosis that my arches/bridges were flatter than normal. While looking at the X-Ray MrRheumatologist B pointed to a area on the X-ray and remarked "Could this be slight sclerosis?". MrRheumatologist C said "no that is nothing". Anyway they sent me to get shoe inserts made and said the pain will go away in 3 months.

[B]Early Jan 2010-[/B] I wore shoe inserts for 4 months and the pain did not increase nor decrease. As always constant and always there. I went back to MrRheumatologistB at the hospital and he was surprised that the pain never went away. He had no further theories and was very curious about the cause co called his superior. A different superior from my last visit, MrRheumatologist D came into the room. They again reiterated that it is not Gout. They refereed me to "Technical ortopedist" at another hospital as they were at a loss to explain why I still had pain.

[B]This week 2010[/B]- Went to see Mr Orthopedist E with his superior Orthopedist F present. They said not Gout related. Their diagnosis is that I have early stage of arthritis of the toe. They said that I should wear stiff soled shoes with rocker effect.
I explained to them that when I wear my canvas super flexible shoes my pain is significantly less. If I wear my Adidas stiffer soled shoes then the pain is clearly more after taking just few steps and it also forces me to walk using the outside of the foot to avoid pain (I had both shoes with me). Orthopedist E found that confusing as stiffer soled shoes normally help in this case and flexible soul is bad for the joint.

His superior Orthopedist F after playing with the Adidas shoe explained that the Addias hurt more because they are not stiff enough ie. they still bend and hence put greater force on the joint. Stiff but still bendable = more force on the joint. I need shoes that don't bend at all according to the Doc. They made me try some stiff shoes and I must say that the pain did not come straight away like with my Adidas shoes. Although I don't know how it will work after few hours of use.

For some reason I am only half convinced with all the consultations I have had. My toes have full movement range and if X-rays are supposedly normal then is it really big toe arthritis? Applying reasonable force against the toe upwards or downwards with my hand re-creates the sharp joint pain. Other times it is like a burning sensation in the general joint area 24/7.

When the pain first started it was pin point accurate pain on the top of my big toe joint. Now it's the whole general joint area and feels like burning sensation deep inside.

My Converse canvas shoes are flat at the bottom and super flexible in all directions and cause the least amount of pain to me. I can walk properly in them apart from the burning sensation that is there 24/7 irrespective of what I wear or not wear (resting or walking)

My Adidias shoes are stiffer soled but not completely 100% stiff. I get extra pain within few steps of wearing them. I don't and can't wear them any more but before this pain thing started they were perfectly comfortable for me.


NOTE- My blood uric acid level is in the 450-650 µmol/L (7.5-10.8 mg/dL ) range generally. Normal should be under 420µmol/L .

Wiki- Gout can occur where serum uric acid levels are as low as 6 mg/dL (~357µmol/L), but an individual can have serum values as high as 9.6 mg/dL (~565µmol/L) and not have gout.

So based on what I have told you what is your opinion? Is it Big Toe arthritis? Should I buy very stiff soled shoes with rocker effect as recommended by the Orthopedist? Is their diagnosis wrong or right? Please any advice would be highly appreciated. I am losing my mind here. Should I ignore my blood uric acid readings as I am being told by everyone?





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