synthesis of purine nucleotides - Turf Toe
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Turf Toe

Turf toe gets no respect. Let's take a closer look at the causes of turf toe and see how to treat it more effectively. Turf toe is actually a form of hallux limitus. Hallux limitus is classically described as pain and progressive decrease in the range of motion of the first metatarsal phalangeal joint (MPJ). The onset of hallux limitus is due to the following:


Tart cherries, fruits, berries Carrots, celery, eggplant, lettuce, radishes, tomatoes, potatoes Non-caffeine sodas Cottage cheese, yogurt, dairy (fat free or low fat)


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"My big toe was in horrible pain, so i went to emergency room. Dr diagnosed gout in my foot and gave me pain killers. I did some googling and found goutezol. I like that it's natural with no chemicals in it. Ive been taking it for about 6 months and so far no attack, and my doc confirmed lower uric acid in my blood. thank you!" Jeff, NY
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 synthesis of purine nucleotides4.) Avoid or limit Alcohol Consumption. 5.) Exercise on a daily basis! Try to get at least 15 minutes of activity per day.

THE CAUTION Rapid changes in uric acid levels can trigger a gout attack. This rapid change can be brought about by many factors in addition to possibly mega doses of Vitamin C and by drugs such as probenecid and sulfinpyrazone. People who are susceptible to gout must consider these rapid changes.

Think of turf toe (hallux limitus) as an isolated case of osteoarthritis limited to the first MPJ. Whether the injury is acute or due to repetitive loading, the result is a load that is applied to the subchondral bone that is greater than what the bone can tolerate. As the injury progresses, a series of micro fractures will develop in the subchondral bone. The typical soft spongy character of the metaphyseal bone changes to become brittle and hard. The result is that the articular cartilage looses its' underlying support and becomes susceptible to damage. Juxtachondral eburnation, osteophytes, lipping, spurring; call them what you like, but what you see on your x-ray is the slow progressive destruction of the joint.

Such a rapid change concerned the authors of one study in the 1970's who had recorded that mega doses of Vitamin C (4,000 mg and 8,000 mg daily) reduced uric acid levels significantly, and by more than in the 2005 study. However, as far as Vitamin C induced changes in uric acid levels is concerned, this triggering has not been reported in any study.

If you know anything about gout, you would guess that Greg was the perfect candidate for this arthritic condition. Greg was 30 pounds overweight, had a sedentary lifestyle (a sitting job), didn't exercise, typically ate high carb/fat meals, loved his beer and was 38 years old. I later realized, I probably could have approached him about wanting to try our natural gout cure as opposed to him coming to me.

3.) Drink half your weight in water! In ounces that is! I weight 180 pounds so I would drink 90 ounces of water per day! Roughly, 11 cups of water per day!

One complicating factor is that elusive fact that most people with hyperuricemia (excess uric acid)do not get gout. Another is that some people with normal uric acid levels do.

A few studies over the past 30 years have concluded that Vitamin C will reduce the uric acid level. They have differed in the amount of Vitamin C given to study participants. A U.S. study of 184 non-smokers, published in 2005, concluded that the amount required to achieve a serum (blood) uric acid level reduction was 500 mg daily. (The Vitamin C was taken as a supplement). This is not a mega dose.

A European study reported a 16 year follow-up of over 9,000 men between 41 and 63 who entered the study with no evidence of coronary heart disease (CHD). After the study follow-up, most men continued to suffer with gout attacks but also were considered high risk for coronary heart disease. And as you might know, 1 out of every 5 deaths is associated with heart disease.

Peanuts, soy and soy products (tofu and soy sauce) Brown rice, whole wheat, malt, whole grain cereal Low-purine foods (foods lowest in purines for low-purine diets)

Let me explain! Curing Gout and Decreasing Your Chance of Heart Disease My career is centered around health! Therefore, my favorite part of the newspaper is the 'Health' Section. And while reading the daily paper, I noticed an article about gout! "Gout Increases Risk of Coronary Heart Disease". I instantly flipped the page and thought 'duh'. But, after thinking about my friend Greg, his family, our friendship, his life... I immediately flipped back and read the interesting article!

But before we go any further, we need to understand that the terms turf toe and hallux limitus aren't really synonymous. The fundamental difference between the two terms is the patient population that they affect. Turf toe is a term used in athletic circles referring to any injury of the great toe joint. Consequently, discussions about turf toe will focus on the first two causes of hallux limitus mentioned above; functional hallux limitus and direct physical injury. On the other hand, when we discuss hallux limitus, we're actually referring to a broader, 'non-athletic' patient population and need to include all three causes of hallux limitus.

Unger, K., Rahimi, F., Bareither, D., Muehleman, C. The Relationship Between Articular Cartilage Degeneration and Bone Changes of the First Metatarsophalangeal Joint. J. Foot Surg. 39:1 24-33, 2000

The holidays are some of the most enjoyable time of the year. We reconnect with distant relatives and make new friends. We enjoy a more relaxed atmosphere at the office and at home we usually find time to slow-down and reflect upon all of the events of the previous year.


Anatomy: The great toe joint, or first metatarsal joint consists of two bones. The proximal bone is the first metatarsal and the distal is called the proximal phalanx or hallux. These two bone move against each other in an up and down motion through what we refer to as the sagital plane. Biomechanics: The motion of the great toe joint is dependant upon the plantarflexion of the first metatasal. If the first metatarsal is limitied in its' ability to plantarflex, the joint will jam resulting in funtional hallux limitus, which as we know is one of the causes of turf toe.

It also reached the well-known and accepted conclusion that hypertension (high blood pressure) and obesity are risk factors for gout. And one other very different conclusion from the conventional wisdom about purines -- purine intake, with the exception of alcohol, was NOT associated with a risk of gout.

However, restricting purines in your diet is not difficult, so it is still worth doing. The conventional wisdom may be correct. Uric acid level tests should tell if a low purine diet works for you.

In the 2005 study by how much did 500 mg of Vitamin C reduce their uric acid level? It found an average, across all participants, reduction of about 10% (0.5 mg/dL). In addition, reductions were larger among participants who had higher levels of uric acid at the start of the study. Participants took the 500 mg daily level for two months. Those who were given a placebo (i.e. not Vitamin C) showed a slight increase in uric acid levels.

Ronconi, P., Monachino, P., Baleanu, P.M.,Favilli, G. Distal Oblique Osteotomy of the First Metatarsal for the Correction of Hallux Limitus and Rigidus Deformity. J. Foot Surg. 39:3, 154-160, 2000

We also get an opportunity to attend numerous holiday parties. Many of these events have great tasting food and drink. However, with all of these temptations we need to remember that a change in diet can cause a painful gout attack. So it makes sense to understand what types of food should be avoided to help manage gout during the holidays.

Coffee, tea, cola drinks Lamb, sausage, game meat Foods in moderation: (foods that should consumed in moderation for low-purine diets) Mushrooms, asparagus, cabbage, dried beans, artichokes, peas

About the author:
Jeffrey A. Oster, DPM, C.Ped is a board certified foot and ankle
surgeon. Dr. Oster is also board certified in pedorthics. Dr.
Oster is medical director of href=http://www.myfootshop.comMyfootshop.com and is
in active practice in Granville, Ohio.

Managing gout is a year-round concern for the millions who have experience the painful deposits of needle-like crystals of uric acid that build up in joint space and connective tissue. These deposits can lead to swelling, heat, redness and arthritis. The proverbial swollen toe often characterizes a gout attack.

0.5 mg/dL is a useful reduction but for most people probably not a natural remedy for gout, although the 0.5 mg/dL figure is an average and some participants did better. But a 0.5mg/dL reduction will not be enough to reduce uric acid below the 6.0 mg/dL level at which the MSU crystals may dissolve. However, when combined with other vitamins for gout, a low purine diet and other natural remedies for gout, it could be.

But like Greg (who has been gout free for almost 8 months now), you can naturally cure gout with simple gout remedies and gout prevention cures! And an added bonus, if you live a gout free lifestyle, I guarantee that you will lose weight and decrease your chance of heart disease in the process.

High-purine foods: (foods that should be avoided for low-purine diets) Alcohol, including beer Seafood, including anchovies, herring, trout, mussels, scallops and ocean perch

What's the actual physical change that takes place in the joint with turf toe? As an easy analogy, consider the changes that takes place when an apple falls from a height and is damaged. The skin of the apple appears intact but the underlying pulp is damaged. In the case of turf toe (hallux limitus), think of the skin of the apple as the cartilage of the joint and the damaged pulp of the apple is the subchondral bone. Mild cases of turf toe (hallux limitus), result in little damage to the subchondral bone and will merely exhibit signs of inflammatory change within the joint. Most authors would refer to these cases as stage one turf toe (hallux limitus). More severe cases result in damage to the joint surface, the subchondral bone or both. These are the stage two and three cases of turf toe (hallux limitus) that show visible change on x-ray. As the subchondral bone becomes increasingly damaged, it will create an uneven supporting surface for the cartilage. An increase in activity results in uneven loading of the joint due to the compression injury of the subchondral bone.

Here is a list of some basic tips if you or a loved one is suffering from gout! 1.) Maintain Your Healthy Weight! 2.) Avoid Eating Meats (Purines)!

What causes gout and how can it be managed and prevented? Gout is typically brought on by the inability of the body to eliminate excess uric acid. Uric acid is a result of the breakdown of purines. Purines are naturally found in the body and in many types of food. So with the temptation of party trays overflowing with food of every type, read on to learn how to manage gout pain during the holidays.

 
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In addition to eating in moderation and maintaining a healthy and balanced diet during the holidays, many are searching for natural ways to manage gout year-round. Several low purine cookbooks are available with dozens of great tasting low-purine recipes.

Nomenclature: First MPJ - the big toe joint Metatarsus primus elevatus - a functional or structural position of the first metatarsal First metatarsal - the foot bone making up the proximal portion of the big toe joint Hallux - the great toe

VITAMIN C AS A GOUT PREVENTOR If 500 mg daily of Vitamin C can reduce uric acid levels, then Vitamin C ought to act as a preventative gout vitamin too. A Taiwan study of males in the late 1990's examined the weight, diet and lifestyles of gout and non-gout sufferers in Taiwan. It concluded that Vitamin C, folic acid (folate) and fibre were protective against gout.

Other conditions - synovitis, crystal deposition diseases such as gout, systemic arthritis, external physical influences such as Dupytren's contracture, etc.

And finally, if you want to follow the same path that Greg and hundreds of other ex-gout sufferers followed, please take a few seconds to consider:

And the kicker! Men with gout were about 50% more likely to die from an acute heart attack than those men without gout! With millions of gout hospital visits each year, and over 500,000 coronary deaths per year... Can you understand the seriousness of gout?

Should you take Vitamin C for gout? The answer is probably yes, but read on for a possibly relevant caution. Gout cures require that uric acid levels be reduced. Vitamins and drugs work in two ways to reduce uric acid levels. One is restricting its supply by inhibiting purine breakdown into uric acid, the other is improving uric acid's breakdown into the urine. Vitamin C is thought to be a uric acid excretory, not an inhibitor. Improving excretion may be more important than reducing production.


Differential Diagnosis: The differential diagnosis of turf toe includes; Arthitis Fracture Gout Joint infection Joint or bone tumor Synovitis

It is typically suggested that people with gout reduce their intake of high-purine foods. Here is a brief list of high-purine foods, foods in moderation and low-purine foods for your review. Although this is not an all-inclusive list, it can provide some insight into healthy eating during the holiday season:

Is the onset of turf toe always the same? Turf toe that is the result of functional hallux limitus is going to be insidious in onset. Functional hallux limitus will usually be seen in younger athletes as they attempt to increase their activity. It may not occur during the first athletic season, or the second, but when it does begin to cause pain, the onset will be more frequent and more severe, varying with activity. This profile of onset is simply due to the fact that the athlete is recreating the injury with every step.

Turf toe caused by a direct injury to the joint may or may not be obvious. Athletes may not remember an incident of pain since they're often distracted by the event or game in which they're involved. The onset of direct injury to the joint may be abrupt, but also may be insidious becoming increasingly more painful as the season progresses. The joint pain will subside with rest only to recur with increased activity. It's not unusual to see symptoms of turf toe resolve in the off season only to recur with renewed exercise.

If you take Vitamin C for gout as a dietary supplement, remember that it is reckoned to work better in a product that contains added citrus bioflavonoids. In addition, because it is excreted quickly, take it twice daily. To avoid excess acidity (lower pH) also take alkalizing minerals, or another alkalizing agent recommended by your doctor.

Treatment of turf toe varies with the type of healthcare provider and includes the use of rest, shoe modifications, orthotics, steroid injections and surgery. The success of non-surgical care will vary with the degree of injury, the rate at which the injury is healing and how much osteoarthritis has occurred. We see varying degrees of success with orthotics that promote plantarflexion of the first ray, effectively treating metatarsus primus elevatus and peroneus longus dysfunction. Simple arch supports can make a significant difference in the symptoms of turf toe. Should our patient not respond to conservative care in a reasonable time period, we are not reluctant to suggest surgical revision to address the problem whether it be revisions of the joint defect, shortening of a long first metatarsal or structural revision of metatarsus primus elevatus. As mentioned before, the clinical appearance of dorsal lipping or visible radiographic changes are suggestive of moderately advanced osteoarthritis, a condition that is only repaired by joint revision or replacement.

How did he do it? He was pro-active about curing gout and began living a healthy lifestyle! And you can too! A Natural Gout Cure- No mediations needed and NO side-effects

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1,000 MG PLUS DOSES If you wish to try Vitamin C for gout in doses over 1,000 mg as part of a natural gout remedy discuss it with your doctor or a qualified naturopathic doctor. The 500 mg level is below the British government's 1,000 mg (1 gram) recommended upper safety level safety limit for Vitamin C. It is half of the maximum amount (1,000 mg) in a Vitamin C tablet sold in the U.S. and many other countries.

Highly concentrated food products are another excellent way to manage gout pain all year long. For example, tart cherries supplements and cherry juice concentrate are an ideal way to manage gout attacks.

References: Lombardi, C.M., Silhanek, A.D., Connolly, F.G., Dennis, L.N., Keslonsky, A.J. First Metatarsophalangeal Arthrodesis for Treatment of Hallux Rigidus: A Retrospective Study. J. Foot Surg. 40:3, 137-143, 2001

Do you want a simple step-by-step natural gout cure treatment that is guaranteed to work? Are you sick of popping pills to 'band-aid' the pain?

Research on tart cherries indicate the natural antioxidants contained in this tiny red fruit can help dissolve the painful crystals that form in the joints. One outstanding product that delivers a highly concentrated dose of tart cherries is Fruit Advantage Tart Cherry supplements.

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Gout can be a life and death ailment if left untreated! I immediately made a phone call to Greg to check up! Greg followed our simple Natural Gout Cure and cured his gout, lost over 20 pounds and his blood pressure was over 15 points lower! I jokingly told him that he will be our 'cure gout poster child'.

When treating turf toe be sure to recognize the fact that there is no nerve innervation in articular cartilage. Pain associated with stage one turf toe (hallux limitus) is either synovial pain or bone pain. If we recognize that painful stage one turf toe (hallux limitus) may be due to bone pain, we then realize that turf toe should be treated aggressively to insure the long term viability of the joint.

Previously it has been thought that the amount needed was at least 4,000 mg (4 grams) daily. For example, Dr. Robert Atkins in his book " Vita Nutrient Solutions," recommended 5,000 -10,000 mg as part of his formula natural remedy for gout.

Functional hallux limitus - biomechanical function that results in metatarsus primus elevatus and subsequent repetitive jamming of the first MPJ. Direct physical injury - injury to the articular cartilage or subchondral bone. These injuries may be due impaction injuries or hyperextension/flexion of the first MPJ.


Symptoms: Turf toe that is the result of functional hallux limitus is going to be insidious in onset. Functional hallux limitus will usually be seen in younger athletes as they attempt to increase their activity. It may not occur during the first athletic season, or the second, but when it does begin to cause pain, the onset will be more frequent and more severe, varying with activity. This profile of onset is simply due to the fact that the athlete is recreating the injury with every step. Turf toe caused by a direct injury to the joint may or may not be obvious. Athletes may not remember an incident of pain since they're often distracted by the event or game in which they're involved. The onset of direct injury to the joint may be abrupt, but also may be insidious becoming increasingly more painful as the season progresses. The joint pain will subside with rest only to recur with increased activity. It's not unusual to see symptoms of turf toe resolve in the off season only to recur with renewed exercise.

If you are interested in managing gout pain year-round with natural solutions consider a drinking plenty of water, eating a healthy and well-balanced diet, drinking cherry juice concentrate and using Fruit Advantage Tart Cherry capsules.


Myrtle Randolph

 
 
     
 
 





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