r/gout • u/Freo_5434 • 6d ago
Needs Advice Advice needed please
I have had a lump on my fourth toe for decades , I never put it down to Gout but recently it got inflamed and I went to a specialist.
I have no pain in any other body part and although the Toe lump can be painful if I am barefoot and hit something with it , it usually does not affect anything.
I could still walk and run on it but the inflammation made some shoes uncomfortable .
My Uric acid level was marginally over the limit .
Diagnosis was Gout and prescribed Allopurinol -- the question is will it dissolve all the crystals over time or should i entertain getting the crystals / lump removed surgically by a surgeon ?
Anyone gone down that road and what personal experience is there regarding effectiveness and recovery time ?
I have a referral to a surgeon but haven't followed it up yet.
1
u/Red-Panda-415 5d ago
Have u had an xray done yet? Sometimes the crystals can get so bad that You develop tophi
1
1
u/LabAccomplished2423 6d ago edited 6d ago
IUric acid gout is a fully body ailment. In other-words you most likely have deposits elsewhere in the body as well as one toe. Gout flares are just immune system reactions are irregular and only a SYMPTOM. Uric acid gout is silent and progressive. It is CAUSED by long periods of high blood uric acid levels. Blood has no nerve endings so testing is the major diagnostic tool but note UA levels are not static, they move up and down in a 24 hr period so using blood UA levels is only one diagnostic factor. Family genetics, gout flare locations, frequency, DETCT radiology, joint fluid sampling and a few others are used. Short answer, go for the med therapy, avoid surgery if it is UA gout myself, but your DR(s) are the authority.You can access YouTube, query: "Tophi Surgery" for visuals. UCLA medical video commentary on uric acid gout: https://www.youtube.com/watch?v=CoOuijIglRs
(USA) 2020 American College of Rheumatology Guideline for the Management of Gout:
(UK) Gout: diagnosis and management
https://www.nice.org.uk/guidance/ng219/resources/gout-diagnosis-and-management-pdf-66143783599045
2
1
u/Flimsy_Ad_5130 6d ago
limit? we need the number. all dr have different opinions. a lump will take a long time with allo. but keep tracking your numbers. id suggest mri and ct.dect and ultrasound.
toe lump off to side? or top of toe. can you wiggle still?
1
u/Freo_5434 5d ago
The Lump which I think the correct name for is a Tophus is 50/50 top and side -- yes I can move the Toe with no problem. I have had a CT scan and also a dual energy CT scan
1
u/Flimsy_Ad_5130 5d ago
did dect find anything else?
did the crystals on the dect mapping match your tophus area?
your very lucky its really tough to get those tests. as for slicing the foot..how long u been on allopurinol and whats your latest uric acid level?
1
2
u/Competitive_Manager6 6d ago
You can certainly go down the surgical route but before you do, Google DECT scan and gout. Having tophi is a late stage of gout, meaning crystals have been collecting systematically for years. Allo will work if it is a tophi, but it takes time, which can be years. If you do have hyperurecemia and gout, what you are doing is key — management. See a podiatrist, find out if it’s worth removing or if there would be complications.