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Dr. Andrew Rynne

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What causes shooting pain in the left big toe?

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Dr. Naval Mendiratta

Rheumatologist

Practicing since :2007

Answered : 748 Questions

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Posted on Fri, 13 Apr 2018 in Lupus
Question: Hello i recently had gout and its gone but tonight i awoke with a sharp shooting pain under my left big toe, (the same toe where i had the gout) for 2-3 seconds - its now gone. Is this from crystals dissolving or new crystals forming? I have been on a low purine diet since i had the gout and have had plenty of water. Is there anything i can do to help the situation now to prevent a further attack? Please advise also if there is a natural way to dissolve the crystals that may be there from my first attack
doctor
Answered by Dr. Naval Mendiratta 6 hours later
Brief Answer:
Recurrent attacks

Detailed Answer:
good evening

thank you for writing on health care magic

Well the gout attack usually comes when new crystals get deposited.Resolution normally doesn't cause pain.. Sometimes it can be short lasting at times it can be prolonged..

I would like to know a few more details before guiding you further

1. how many attacks you get in a month and has it worsened since last year or so

2. what was your last uric acid

3. any medications you have been taking for It?

4. any other joints affected apart from great for

Do let me know these queries..

Regards
Dr naval


Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Naval Mendiratta 3 hours later
Hi Dr. Naval

thanks for your response, kindly see below my clarification:

Last night's shooting sharp pain for 2-3 seconds was at the tip of the base of my left toe, not at the joint, where the gout attack occurred some 15 days ago. I woke up and walked around and then had some water and 2 capsules of Cherry and Celery Seed in case of an attack...I don't have any swelling in my toe today nor any discomfort - I had slight discomfort at the ball of my foot when I woke up in the morning but none since and no real pain. Essentially other than that 2-3 seconds of shooting pain at the tip of my toe, I have no other symptom today. I have been monitoring my pH and it has been 6.5-7.25 consistently over the past 2-3 days so I was a bit surprised.

See below, responses to your questions:

1. how many attacks you get in a month and has it worsened since last year or so
- only 1 major gout attack (28th of Oct lasted 15 days)
- 2 minor toe inflammation events about a month before that and 6 months or so before that lasted 1 day only

2. what was your last uric acid
- I'm not sure this was ever measured perviously but I did have a blood test for UA and should have results this week

3. any medications you have been taking for It? - none for the gout except for NSAID (Advil, Aleve and then Indomethancin for 5 days, 1-2 times a day)

4. any other joints affected apart from great for
- No other joints affected with gout - my right pointer finger right side joint sometimes gets inflamed slightly after hot yoga

Please let me know if you think whether the shooting pain was from uric acid crystals dissolving and flowing to the tip of the toe (it did not hurt in any joint) or if you think this was formation of new crystals - I did not think crystals formed in an alkaline environment (7.25 and up) or slightly acidic (6.5-6.75). Please let me know what I can do to naturally contain this - I have switched by diet from below:

Heavy red meat, sugar and alcohol (last 10 years) plus extensive hot yoga (2 years, where my urine was dark yellow after exercise) to now:

Vegetarian diet, no sugar, no alcohol, 12-14 glasses of water + omega 3, tart cherry, celery seed, and probiotic supplement; no carbs or minimal only.

I would appreciate your experience and any collective expertise you may have to help me solve this without medication - I will know my UA results only in a few days by which time this question will time out - is there a way to interact longer due to the seriousness of this issue?

thank you kindly XXXXXXX

doctor
Answered by Dr. Naval Mendiratta 20 hours later
Brief Answer:
Gout management

Detailed Answer:
Good evening XXXXXXX

Sorry for the late reply. had a long day here

1. Well as per the attack, it is very difficult to say it was gout since it lasted 2-3 seconds and had no further swelling or pain...It looks a bit unexplained. Crystals dissolving is a different phenomenon all together....When crystals are deposited for long time they form Tophi... Tophi are visible and from there the crystals resolve with medication...Other crystals usually go off when attack subsides....

2. As for the medications, you dont need much for long duration. But during the attack I would prefer starting Tab Colchicine 0.5 mg twice daily, to be taken for 3-4 weeks as it reduces the rate of further relapses.

3. Do let me know your uric acid. If it is very high we may need to consider medicines. Also get your lipid profile, fasting blood sugar checked...Since high uric acid is happening at your age, we need to see other causes as well.

4. As for the body PH, I am not very sure how much it helps in preventing uric acid formation. For urine it is recommended, but not something that you need to stress out daily for it..

5. As for diet, you are doing good. Include dairy products as well. Milk, curd help excrete uric acid

Would like to know the blood levels before telling you about seriousness

Hope the information was useful

Do let me know for more queries

Regards
Dr Naval
Above answer was peer-reviewed by : Dr. Prasad
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