Gout Treatment (Medication) in Singapore

Surprisingly, gout (podagra) affects about 1 in 40 individuals. It is a form of arthritis that causes stiffness, tenderness, and pain in the joints. It can make movement difficult and very painful. Luckily, gout treatment can help you manage your symptoms. Orthopaedic care offers a holistic approach to treating gout.

At the Singapore Sports and Orthopaedic Clinic, our qualified experts can help find the best solution and gout treatment in Singapore, for you and your lifestyle.

What is Gout?

Gout (podagra) is a disease that results from an overload of uric acid in the body. This overload of uric acid leads to the formation of tiny crystals of urate that deposit in tissues of the body, especially the joints.

Gout - Anatomy of Feet

When crystals form in the joints, it causes recurring attacks of joint inflammation (arthritis). Gout is considered a chronic and progressive disease. Chronic gout can also lead to deposits of hard lumps of uric acid in the tissues, particularly in and around the joints and may cause joint destruction, decreased kidney function, and kidney stones (nephrolithiasis).

What Causes Gout?

  • Intake of alcholic beverages
  • Hereditary
  • Increase in level of uric acid
  • Starvation and dehydration
  • Trauma

Thousands of years ago, gout was considered the ‘disease of kings.’ Why? Certain foods with a high purine content, such as shellfish and red meat, and alcohol trigger gout attacks. During this era, these foods and alcohol were limited to royalty and the extremely wealthy. Thus, middle and lower class civilians rarely experienced the disease.

Today, the prevalence and incidences of gout have steadily increased. Our diets have changed. And with technology, we can detect and diagnose gout much easier than ever before.

Gout is caused by a buildup of uric acid in the body. Usually, the kidneys filter and then excrete uric acid through the urine. In certain circumstances, the body may produce uric acid at a higher rate than it can expel it. When uric acid levels in the blood become too high, the body deposits monosodium urate crystals in the joints. These crystals irritate our joints, and cause the symptoms commonly associated with gout including:

  • Tenderness
  • Pain
  • Stiffness
  • Redness
  • Inflammation

The body may be unable to keep up with uric acid levels for a number of reasons. Our body breaks purine down into uric acid. Purine is found in alcohol beverages, various meats, and seafood. When we consume foods high in purine, our bodies may lack the ability to keep up with the production of uric acid. This results in hyperuricemia, or high uric acid levels, in the blood.

In other cases, kidney impairment may cause higher uric acid levels. If the kidneys are unable to excrete uric acid, it builds in the blood. Impaired kidney function may occur due to diabetes, cancer, high blood pressure, thyroid disorders, or kidney failure.

Genetics and certain medications are also thought to play a role in the development of gout. For example, diuretic medication used to treat high blood pressure can lead to gout. Diuretics increase your fluid output. Yet, the fluid left in the body may become highly concentrated with uric acid. Doctors advise drinking plenty of fluids when taking diuretics and avoiding foods high in purine to reduce the risk of gout.

How is Gout Diagnosed?

Prior to gout treatment in Singapore, a proper diagnosis must be made by a physician. Your doctor may take into account a number of factors. They may assess and ask questions relating to the following:

  • Are you overweight?
  • Do you consume a diet high in purine foods?
  • Do you regularly consume alcoholic beverages in high amounts?
  • Are you on certain medications, such as diuretics?

A joint fluid test and blood test will confirm a gout diagnosis.

In a joint fluid test, fluid is taken from the inflamed and painful joint via a needle. If crystals are present in the fluid, a gout diagnosis is made. Your doctor may further order an x-ray to ensure the pain is not caused by other problems.

Exploring the Relationship Between Gout & Joint Pain

Gout can cause sudden intense painful attacks at the joints, causing swelling and redness of the joint tissues. It usually attacks the joint of the big toe but this does not rule out the attacks on other joints. Gout usually affects men with 9 out of 10 patients being men. Once gout starts to attack other joints, it leads to inflammatory arthritis. Let’s look at the relationship between Gout and Joint pain here.

Gout happens due to an excessive accumulation of uric acid. Uric acid is formed when the body breaks down an aromatic organic compound called purines. Purines are found in foods such as livers, beans, mackerel and beer. Overconsumption of such foods will lead to a high level of purines, resulting in too much uric acid. The body’s natural mechanism of dealing with uric acid is by passing them out through urination but when this urination process is less efficient, hyperuricemia occurs, leading to gout.

Gout happens through 3 basic stages:

Asymptomatic Hyperuricemia

This is the onset of gout. In this first stage, the patient starts to have an excessive accumulation of uric acid in the body but no other symptoms or problems are present. It is also in this stage that the problem can easily be reversed by significantly reducing the amount of purine-rich foods.

Acute Gouty Arthritis

When no actions were performed to limit the consumption of purine-rich foods, the uric acid levels will increased and lead to the formation of uric crystals in the spaces between the joint. Due to the crystals and high acidity, sudden onset of intense pain will occur and this can lead to swelling in the joints. Attacks will be infrequent and can be spaced weeks or even months apart from each, but as time passes, the attacks will become more and more common.

Chronic Tophaceous Gout

This stage is the most serious and will only happen after 10 years. A patient will only reach this stage when he makes no attempt to seek treatment and gout has caused a permanent damage to the joints and kidneys.

There is an exponential relationship between gout and joint pain, leading to sudden onsets of pain attack and swelling. However, reaching from one stage to the other takes time and during the periods, it can be treated by medication and reduction in consumption of purine-rich foods. Gout will cause a lot of trauma and severely affect patients.

How is Gout Treated?

In some cases, gout is very dehabiliting. It can happen suddenly and be very painful. The most common spot for gout to occur is in the big toe. Although, it may spread to the ankles, feet, and knees.

Fortunately, gout is a very treatable condition. And we offer a variety of ways to treat the disease. When a gout attack occurs, it will often resolve on its own in about a week. Thus, many health professions focus on relieving the symptoms and preventing future incidents.

Medications are the most common go-to. NSAIDs, nonsteroidal anti-inflammatory drugs, may alleviate swelling and pain. Your doctor may also prescribe stronger pain medication if over-the-counter drugs aren’t helping. Medications that help lower uric acid levels may also be considered. These type of medications help to prevent attacks by reducing the production of uric acid.

However, long-term use of most of these drugs is not recommended. Surprisingly, NSAIDs can have fairly dangerous side effects. With chronic use, heart problems may arise. Prescription NSAIDs are particularly problematic for this. You may experience gastro-intestinal issues. These medications may cause bleeding and ulcers when used for long-periods or at high dosages. Such medication may also lead to further impaired kidney function, which not only doesn’t help the problem but can amplify gout occurrences and symptoms. When using any medication, make sure to follow the direction on the label and read the warnings prior to consumption.

Your healthcare provider may also consider the medication you are currently taking and make modifications where it is necessary.

If your diet is the main problem, your healthcare provider may discuss other dietary options that do not increase your risk of gout. They will advise you to avoid foods high in purine and to drink plenty of water throughout your day.

In short..

The treatment of an acute attack of gouty arthritis involves measures and medications that reduce inflammation. Preventing future acute gout attacks is equally as important as treating the acute arthritis. Prevention of acute gout involves maintaining adequate fluid intake, weight reduction, dietary changes, reduction in alcohol consumption, and medications to lower the uric acid level in the blood.

Maintaining adequate fluid intake helps prevent acute gout attacks. Adequate fluid intake also decreases the risk of kidney stone formation in patients with gout. Alcohol is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism to cause hyperuricemia. Therefore, alcohol has two major effects that worsen gout by slowing down the excretion of uric acid from the kidneys as well as by causing dehydration, both of which contribute to the precipitation of uric acid crystals in the joints.

Orthopaedic Care & Gout Treatment in Singapore

At the Singapore Sports and Orthopaedic Clinic, our experts can diagnose, treat, and prevent joint, neuro, and muscular disorders, such as gout. They can provide exercise and nutritional advice to help treat gout.

Your doctor will address your nutritional and lifestyle choices, in combination with manual manipulation of the joints to eliminate your pain, improve mobility, reduce the incidences of gout attacks, and help increase your overall quality of life.

Your healthcare provider may recommend the following foods to replace high-purine content foods in your diet:

  • Low fat dairy products
  • Vegetables
  • Legumes
  • Whole grains
  • Nuts
  • Water

Surgery is a rare option for treating gout. However, in cases where there is a lack of draining, the area has become infected, or movement is severely impacted, surgery may provide the best option.

Your healthcare provider may also recommend specific exercises to reduce joint pain and increase support to the commonly affected areas. Weaknesses in the body may lead to pain and conditions such as gout. Strengthening around these areas can lessen the pain symptoms associated with the condition. Weight management is also important to limit the stress placed on the joints that are prone to gout attacks. Your treatment will likely involve an exercise program tailored to your specific needs, including strengthening exercises and possible weight loss strategies.

Get the advice you need and the proper care and treatment for your condition. Frequent and painful gout attacks do not have to be your normal.

At the Singapore Sports and Orthopaedic Clinic, our qualified doctors will find the appropriate gout treatment in Singapore for you. Our team of doctors are experienced in treating orthopaedic problems, sport injuries, and degenerative changes. Start your life free of pain. Get back to the activities you know and love. Call and book your appointment, today.

Should I Have Bunion Surgery? – Pros and Cons

When it comes to everyday life your feet play a huge role. They take you from one place to the next, help you get where you need to go, and enjoy life playing sports, hanging out with friends and family, and just in general taking care of you. What happens you’re dealing with the pain of bunions or even embarrassment of the problem? Suffering with bunions on your feet can be painful and make it hard to enjoy everyday life activities that you so want to take part in.

There’s a variety of bunion treatment options and bunion surgery is one of them. Some people opt to have the surgery so they can wear their favorite shoes or sandals again, and to get rid of the pain. Others tend to wait until it’s the only option left before choosing bunion surgery as their treatment option. Here is a look at the benefits and disadvantages of having the surgery on your feet.

Pros

One of the main benefits to having bunion surgery is the relief of pain. Bunions can cause quite a bit of pain in your feet and make it impossible to enjoy your favorite activities such as walking or jogging. By having the corrective procedure, your pain can be a thing of the past. It also means you can become more active as the pain may have stopped you from exercising or moving.

Another benefit to the surgery option is that you will be more comfortable with the look of your foot. As bunions can become quite large, some people feel ashamed to wear sandals or shoes that shoe their feet. By having the surgery, you can start to enjoy your shoes again.

One other benefit to this type of bunion treatment is that you can get the best results with surgery. When you work with a surgeon who specializes in this treatment, you can get the most efficient treatment of your bunions.

Cons

While there are many benefits to this bunion treatment, you should also consider the downsides. There can be reoccurrences of the bunion a year or so down the road. It may come back in the future. You will experience some pain after the surgery still as it takes time to heal the foot completely. It can limit the shoes you wear during the healing process and even after it depending on the type of shoe you are trying to wear.

Of course, as in any surgery, you can have trouble in walking afterwards as your body tries to heal. There’s also a slight chance that the correction will not work or be successful.

Be sure to weigh all the pros and cons with your medical practitioner to make sure that bunion surgery is your best option.

Symptoms And Treatments For Osteoarthritis Of The Big Toe

Osteoarthritis is a form of degenerative arthritis that causes pain and swelling in joints. Due to the wear and tear of cartilage in the joint, the bones become more prominent and as a result, rub against each other as they move. While the condition occurs gradually, it worsens over time if left untreated. The big toe is a common area to be affected by osteoarthritis.

Causes

Most cases of osteoarthritis come with age, starting from ages 30 to 60. As the body system slows down, the cartilage deteriorates faster than it can heal, resulting in osteoarthritis to develop.

Obesity also increases the risk of developing the condition. With additional pressure from the body weight, the bones of the feet are stressed and may accelerate the damage of cartilage in the big toe.

Some people are born with an overgrowth of the big toe bone, making the toe joint stiff and difficult to bend, thus more susceptible to developing osteoarthritis.

Symptoms

Some of the first signs of osteoarthritis of the big toe include stiffness, achiness, tenderness and pain in the affected toe, though may also be felt in the arch of the foot and other toes. The toe feels most achy and stiff in the morning and after sitting for a long period of time.

Gradually, you would start to notice swelling around the joint. It might be some time before the bone spur becomes visibly noticeable. However, you would feel the bones rubbing together and causing the area to swell as they get more prominent.

As the big toe gets stiffer, it gets harder to bend the toes. Walking and balancing becomes difficult and painful. The constant rubbing between the toes can cause corns and calluses to form, and even leading to other conditions such as hammer toes.

Treatment

Conservative treatment for osteoarthritis may not cure the condition but can relief the symptoms. Your doctor might prescribe painkillers and anti-inflammatory medicine to ease the pain and bring down the swelling. There are also creams and gels to reduce the swelling. Orthoses can be inserted in your shoes to decrease the pressure while walking. It is best to avoid high heels and pointy-toed shoes as these shoes give puts stress on the feet and may aggravate the symptoms.

For very severe cases, your doctor might recommend a joint replacement surgery. The damaged cartilage is removed and the joint is held together in a fixed and immovable position so that the cartilage would not be affected again. However, the results of the surgery might cause a reduction in mobility. Thus, this procedure may only be suitable for elderly patients that do not require as much mobility in daily activities.

What Is Hallux Rigidus: Cause, Symptom & Treatment

Hallux rigidus is a stiff big toe that occurs when there is an overgrowth at the base of the big toe. It prevents the toe from bending, causing pain and difficulty in walking and standing. This is a disorder of the joint and a form of degenerative arthritis that usually develops between the ages of 30 and 60.

Causes

This condition could be inherited from parents, bearing an abnormal foot structure at birth that is more prone to developing hallux rigidus. It could also be an overuse injury – athletes or people who are constantly engaged in activities that add stress on the big toe, such as squatting and standing, are at higher risk.

Other causes include injury to the toe that damages the articular cartilage, causing the ends of the bones to rub together, and inflammatory diseases such as rheumatoid arthritis or gout.

Symptoms

Some of the symptoms you should look out for are pain and stiffness during walking, standing or even at rest, and the pain worsens in cold weather. Bending of the big toe is very difficult or impossible. There might be swelling around the big toe joint and a bump on the top of the foot. Patients might compensate the inability to use their big toes when walking by using the strength of the hip, knee or lower back, causing pain in those areas. This might lead to walking with a limp over time.

Treatment

Patients should seek medical help once the first signs of symptoms appear as the longer it is delayed, the more difficult it is to treat. If the condition is diagnosed early, non-surgical treatment may suffice for treatment. But if diagnosis is delayed or if the condition is severe, surgery is unavoidable.

Non-Surgical Treatment:

To first reduce the pain and inflammation, oral medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed. For progressive recovery, patients have to wear shoes with rocker-bottom soles and a large toe box to reduce pressure on the big toe. Orthotic devices are used to support the foot, so that the toe does not have to bend when walking. Physical therapy is recommended for reducing inflammation and improving foot function with exercises.

Surgical Treatment:

If the symptoms do not improve with non-surgical treatment, patient would have to go through surgery. One method is to remove the bone spurs and some part of the bone to make space for the joint to bend. For more severe cases, the bones are fused together, making the joint unable to bend permanently but relieving the pain.

Joint replacement surgery helps to both relieve the pain and preserve joint motion but is usually only recommended for elderly patients that do not have much physical demands.

Tarsal Coalition: Diagnosis & Treatment

Tarsal coalition is a congenital condition that occurs when the tarsal bones at the back of the foot are abnormally connected, causing pain and limitations in walking. Because of the joint bones, the foot may appear to be made up of a “bar of bones”, looking flatter and stiffer than a normal foot. Depending on the degree of attachment, if the bones are connected by fibrous tissue, the foot would be more flexible compared to a bony connection. About 1% of the population is affected by tarsal coalition.

Causes

Most cases are present at birth as the tarsal bones fail to separate during foetal development. And because tarsal coalition is an autosomal dominant genetic condition, children are likely to inherit the disorder if one of the parents has it.

Symptoms

The symptoms may only appear later in life or when the bones are beginning to mature. The most common sign is pain on the outside of the foot along the fibula, especially when walking or standing. The foot feels stiffer and flatter, and the patient might walk with a limp because of the rigid bone structure. Over time, other joints may be affected and pain is felt at the outer top side of the foot.

Diagnosis

Because the bones are still developing during childhood, it may be difficult to diagnose until the bones begin to mature at about 9 years old. Some people only discover it during adulthood when affected by the symptoms. To help the doctor diagnose, it is important to give a full history of the duration and development of the symptoms, together with the activity level involved in the patient’s daily life. The patient’s walking movements are observed and followed by a thorough physical examination of the foot to look for tenderness and restriction of motions in the joints.

Treatment

Depending on the severity of the condition, surgical or non-surgical treatment can be used to relieve the symptoms and reduce motion of the joints.

Non-Surgical Treatment:

The foot is immobilized in a cast or brace for two to four weeks to allow the joints to rest. Steroid injections and oral medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce the pain and inflammation. After the cast is removed, custom made orthotics is placed into footwear to support the joints and reduce pain when walking. Patient may have to go through regular physical therapy sessions.

Surgical Treatment:

If the patient does not respond well to non-surgical treatment and the symptoms do not seem to subside, or if the condition is too severe, surgical treatment is opted for.

Depending on the age of the patient that tells the maturity of the bones, the goal of the surgery is either to restore the motion of the joints by removing or excising the bones, or fusing the joints together to form a solid bone. Removing or excising the bones is only recommended for young children as restoring motion in more mature and degenerative bones may not be enough to stop the pain.

What Is Progressive Flatfoot? Signs, Causes & Treatment

Another name for progressive flatfoot is Posterior Tibial Tendon Dysfunction. The posterior tibial tendon is found in the calf down to the inside of the ankle to the middle section of the foot. It is responsible for holding up the arch of the foot and gives us support when walking. Progressive flatfoot happens when the tendon becomes inflamed, stretched or torn, causing the arch to collapse.

Not to be confused with plantar fasciitis, which is the inflammation of the plantar fascia, causing the bottom of the foot to hurt and swell. While progressive flatfoot is an injury to the tendon, plantar fasciitis is a strain to the ligament.

Signs

Patients with progressive flatfoot will experience pain on the inner side of the ankle. The arch of the foot is now flat and pain gradually develops on the outer side of the ankle as well. Patients may be unable to or experience difficulty in supporting their weight on their toes.

Causes

Progressive flatfoot is often caused by trauma to the ankle from sports or outdoor activities such as soccer, running and hiking. The posterior tibial tendon is overstretched, resulting in inflammation. This condition can also happen to patients with an abnormality of the tendon, usually women over the age of 50. Obese and diabetic patients are also at higher risk for this injury.

Treatment

Treatment is important to prevent chronic pain or even disability. If left unattended, the tendon would stiffen up and it might be difficult to walk or wear shoes. Arthritis would develop in the hind foot and the pain would spread to other parts of the ankle.

Non-Surgical Treatment:

If the condition is mild, patient would be wearing a cast or brace for 6-8 weeks to prevent the foot from weight bearing. At this point, anti-inflammatory drugs and plenty of rest are needed to recover. Patient would need to wear a shoe insert to support the arch after the cast is removed.

Surgical Treatment:

For more severe cases or if the condition does not get better with non-surgical treatment, the doctor would recommend surgery. The surgical procedure may include cleaning away inflamed tissue, changing the alignment of the heel bone, repairing the damaged tendon, recreating the arch of the foot or joining two bones together to stabilize the hind foot.

Adult Acquired Flatfoot: Cause, Symptoms and Treatment

Adult acquired flatfoot deformity (AAFD) is not present at birth and only acquired during adulthood between 40-60 years of age. Usually caused by damage to the posterior tibial tendon, the arch of the foot gradually collapses as the tendon gets inflamed or torn.

Causes

There are a few categories of people more likely to develop AAFD – Women over 40, diabetic patients, obese people and patients with hypertension. Such conditions provide a higher risk to overstretch or rupture the posterior tibial tendon, leading to AAFD.

Other causes of AAFD are rheumatoid arthritis, bone fracture or dislocation. These conditions cause the tendon to be weaker and subject to impairment. Those with flatfoot since birth are also more prone to AAFD later in life.


Symptoms

One or more of these symptoms may be experienced depending on the cause of the AAFD.

  • The foot is angled in an awkward position. One way to check is to view from the back of the foot. For a normal foot, only the fourth and fifth toes can be seen from the back. If the big toe can be seen, chances are AAFD has developed.
  • Pain and swelling along the inner side of the foot causing difficulty to tiptoe.
  • Aggravated pain from long periods of standing or walking, or from high intensity physical activities.
  • Pain in the anklebone that feels like arthritis.
  • Numbness and tingling on the top of the foot and in the toes caused by bony bumps developed from old injuries.
  • Diabetic patients may only notice the swelling but not feel any pain due to their impairment of sensation.

 

Treatment

Most cases of AAFD can be treated without surgery. If the condition is not improved after nonsurgical treatments, surgery is needed to realign the foot.

Nonsurgical:

  • Shoe modification may help for mild conditions. A shoe insert or customized shoes that give arch support can be easily purchased from stores.
  • Customized braces and foot orthoses are fit tightly around the leg to prevent it from moving in certain angles and correct the alignment of the foot.
  • Physiotherapy helps to strengthen leg muscles and guide foot movements.


Surgical:

Depending on the type and severity of deformity, one or a combination of these procedures might be used if nonsurgical treatments show no improvement.

  • Repairing of the posterior tibial tendon and removing inflammatory tissue.
  • Tendon transfer if the posterior tibial tendon is badly damaged.
  • Bone surgery is done to recreate the arch and realign the bones, which are then held in place with screws and plates.