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Gout is a type of arthritis characterized by too much uric acid in the blood. Uric acid is a natural waste product of the body that is normally filtered out of the bloodstream by the kidneys and excreted during urination. Patients with gout have an abnormal metabolism that reduces the kidneys' effectiveness. Uric acid then accumulates in the blood and forms painful crystalline deposits in one or more joints or soft tissues, usually in the feet and legs. The most commonly affected joints are the big toe and knee.

The classic symptoms of gout are swelling, redness, warmth and a stabbing or throbbing pain in the affected joint. Symptoms usually appear suddenly. Acute attacks are treated with anti-inflammatory drugs to reduce swelling and pain. Attacks that recur over time can damage the joint, so patients with the chronic condition will typically be prescribed a medication that reduces uric acid levels in the blood.

Gout occurs most frequently in men and some post-menopausal women. Those at increased risk of developing gout include patients with diabetes or kidney damage, women who have had a hysterectomy, and people who ingest alcohol, red meats, aspirin and some blood pressure medications.


Hammertoes are an abnormal "V"-shaped bending of the little toes. Caused by stiffened tendons, hammertoes often form because of a muscle imbalance, arthritis, a hereditary condition, an injury, or tight shoes that squeeze the toes. They may be flexible (the toes can still be moved at the damaged joint) or rigid (the toes are immobile). Many people with hammertoes develop swelling, redness, stiffness, or painful corns or calluses as the toes rub against the inside of the shoes.

Ingrown Toenails

An ingrown toenail is a common condition that involves the corner of the toenail growing into the skin of the toe, causing pain, swelling and infection. This can occur as a result of wearing shoes that are too small or tight, cutting the toenails too short, injury to the toenail or a naturally curved toenail. While this condition can affect any toe, it most commonly affects the big toe. If left untreated, an ingrown toenail is likely to develop an infection and may even require surgery to remove the nail.

Most ingrown toenails can be treated at home by soaking the foot in warm water, applying antibiotic cream to the area and wrapping the toe in gauze or bandages. It is important to keep the area clean to help prevent infection. Your doctor may also place a piece of cotton under the nail to separate it from the skin that it is growing into, encouraging growth above the edge of the skin. For more severe or recurrent cases, part of the nail and the underlying tissue may be removed in order to remove the infection. Removal can be done through a chemical, laser or other methods.

Patients can prevent ingrown toenails by protecting the foot from trauma and by wearing comfortable, well-fitting shoes. Patients with diabetes may be at a higher risk for infection or other complications of ingrown toenails, and should take special precautions to prevent them from occurring.


In-toeing, also known as pigeon toes, is walking with the feet pointed inward. This condition commonly occurs in babies, between 8 and 15 months, when they first begin to stand.

Causes of In-Toeing

In-toeing can be the result of several common causes:

  • Tibial torsion - a twisted shin bone
  • Femoral anteversion - a twisted thigh bone
  • Metartasus adductus - abnormal inward bending of the foot

It is thought that a family history of the condition may play a factor in a child developing in-toeing. Another cause of in-toeing may be a lack of space in the womb during fetal development.

Symptoms of In-Toeing

In most cases of in-toeing, both legs are equally affected. This condition is usually diagnosed before the age of three, but is most prominent between four and six. Some children may experience pain around the knee, but most cases of in-toeing are painless and do not produce any associated symptoms.

Treatment of In-Toeing

In-toeing does not usually require treatment and often corrects on its own. Special braces were used, in the past, to correct the condition, but it has been shown that most cases of in-toeing gradually correct on their own. As the child matures, in-toeing usually does not interfere with physical activity. In severe cases, surgery is indicated only if the child has reached the age of 8 and their degree of measured anteversion exceeds normal range.

Joint Replacement

Sometimes the best way to relieve pain and restore function to a joint is to replace all or part of it with a mechanical prosthesis. Prostheses are intended to relieve pain associated with arthritis, other chronic conditions, or traumatic injury. The most commonly replaced joints are the hip, knee, shoulder and wrist.

Occasionally, an implanted prosthesis does not function as well as it was intended to. In this case a revision procedure may be performed to adjust or replace the mechanism.


A neuroma is a painful swelling of a nerve, usually in the ball or heel of the foot. Symptoms include sporadic pain; burning, tingling or numbness of one or more toes; and a popping sensation when walking. Pain is often soothed by taking weight off the foot or by massaging the area.

In the foot, there are the long bones (metatarsals) and thin nerves running between them. The nerves split in a Y-shape when they reach the toes. If the metatarsals move abnormally, they can pinch the nerve between them, causing inflammation and, eventually, permanent nerve damage. Morton's Neuroma is the most common of this type and affects the nerve between the third and fourth toes. Neuromas may also occur after a nerve has been injured, either from a traumatic wound or from damage suffered during surgery.

A physical examination and one or more imaging tests will determine whether the pain is caused by a neuroma or by a condition with similar symptoms such as arthritis, stress fractures, tendon inflammation, tarsal tunnel syndrome and nerve compressions in the ankle or leg. Treatment begins with a combination of cortisone injections to reduce swelling and orthotic inserts to correct problematic metatarsal movement. If the nerve is permanently damaged, the patient may decide to undergo chemical destruction of the nerve, have the nerve surgically removed, or endure the pain.