Gout Treatment in Anchorage, AK


Gout is caused by an elevation of uric acid within your blood.  Uric acid is a natural substance in your body that is a breakdown product of proteins.  Gout occurs in people who either make too much uric acid, eat too many foods that are high in uric acid, or in people who cannot get rid of excess uric acid in their blood.  Gout medicines focus on helping your body produce less uric acid, or helping your body eliminate excess uric acid.

Where does Uric Acid come from?

You naturally produce most of the uric acid in your body, but there is a percentage (up to 20%) of uric acid that comes into your body through diet.  Adjusting your diet by avoiding foods high in uric acid can help reduce your chances of repeat gout attacks.  In addition, keeping yourself very well hydrated with water is helpful.  Some medications can make a gout attack more likely, including some blood-pressure pills (water pills).  Your doctor may adjust these medications if gout becomes a problem.

In addition to medicine, you can help avoid future gout attacks by following the following diet guidelines:

Eliminate the following:

Liver    Kidney     Anchovies      Sweetbreads   Sardines      Brains     Heavy gravies      Heart    Fish roes    Mussels     Herring    Beer / Wine    Meat extracts, consommé


Reduce the following foods to no more than one serving per day:

Meats     Beans   Fowl     Peas   Cauliflower   Mushrooms Other seafood   Lentils     Spinach Yeast      Asparagus    Whole grain cereals    Fish (except noted above)

These foods do not cause gout:

Fruits     Milk       Cheese    Eggs     Refined cereals   Nuts   Spices (including salt)   Sugars & Sweets    Vegetable soups (clear)    Vegetables


Diagnosis & Treatment

A blood test may be used to test the uric acid level.  It is common; however, that the blood level of uric acid may be normal even while a person is having a gout attack.  If the diagnosis is in question, a sample of joint fluid may be taken and tested for gout crystals.  Most cases of gout affect the big toe joint but other areas can also be affected.  The pain can be quite severe and result in joint swelling and redness.  Walking may be difficult and pressure of a shoe or even bed covers can be painful.  Treatment for the acute, severe pain may include anti–inflammatory medications (such as indomethacin or colchicine) or injections near the area.  A sandal or surgical shoe may be useful to relieve pain as well.

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Ganglion Cyst Treatment in Anchorage, AK


What is a ganglion?       

Ganglion Cysts are a benign fluid-filled lump (cyst) that can occur in many areas of the body, but is most common on the hands and feet.  They typically arise over a joint or tendon.  Although the exact causes are not known, a ganglion likely occurs due to a weakness in the covering of the tendon or joint space. Direct injury or everyday minor trauma can potentially be a cause.  Motions of a tendon over a bony prominence or pressure from a shoe on a tendon or joint are examples of minor trauma.  Weakness in the covering with a subsequent swelling of liquid into a confined space causes the lump to form.  The growth is usually very firm but may be somewhat soft, depending on the fluid content.  The fluid itself is usually similar in appearance to a thick clear jelly.


A diagnosis of ganglion cyst is usually made on clinical examination based on location of the growth and pertinent history.  An x-ray may be taken to rule out a bone spur as the aggravating factor behind the formation of the cyst.  If there is any question as to the extent of the growth, an MRI may be ordered for a more detailed evaluation.


Proper treatment is based on pain, size, location and aggravating factors. Once a mass is diagnosed as a ganglion cyst it may be left alone, untreated, if it is not painful or causing problems with shoes. Occasionally these growths will spontaneously disappear.  Cysts can be drained by needle aspiration followed by a cortisone injection in an effort to prevent the cyst from filling again.  Once drained, a compression dressing is worn over the site for a period of time in an attempt to reduce recurrence.  Over half of the cysts will refill with this form of treatment, but the upside is that the procedure can be repeated again if needed.  If the growth is a source of pain or irritation and drawing fluid out (aspiration) has failed, then surgical excision may be necessary. Although surgical excision reduces the chance for recurrence ganglions will sometimes come back.  Surgical excision is an outpatient procedure.   Crutches and non-weight bearing are not usually needed.   A surgical shoe is usually worn for 2 to 3 weeks during the time that the incision is healing.  There really is no preventative care for ganglion cysts due to their spontaneous nature.

It is important to be evaluated by a foot and ankle specialist to ensure proper diagnosis.

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Fungus Infection Treatment in Anchorage, AK


Fungal infection of the foot, or Tinea pedis (athletes foot), is a superficial infection caused by a dermatophyte. Dermatophytes are fungi that thrive in a nonviable tissue of the skin, nails, or hair. Trichophyton and Epidermophyton are the principle genera causing infection. Dermatophytosis can involve the entire plantar foot with extensive scaling, hyperkeratosis or even bulla formation. Infection between the toes (Tinea pedis interdigitalis) is quite common. When involvement of the nails occurs (onychomycosis) they take on a very thick, discolored (yellow/brown) appearance. Diagnosis is usually clinical, but a fungal culture or potassium hydroxide mount (KOH) of skin or nail scrapings can help diagnose unclear presentations by showing the presence of a fungal organism within the sample.

 Tinea pedis can usually be resolved after several weeks of treatment with topical medications. Oral antifungals (i.e., Lamisil, Griseofulvin,) can be used for extensive infection or poor topical response. Onychomycosis is more difficult to eradicate. Topical therapy results are poor, and recurrence is common after completion of successful oral treatment. Temporary nail avulsion or permanent nail removal (matrixectomy) may be indicated for several deformed, painful onychomycotic nails.

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Bunion (Hallux Valgus) Treatment in Anchorage, AK


Hallux valgus (bunion deformity) is a misalignment of the first metatarsophalangeal joint (MTPJ) that causes the big toe (hallux) to deviate towards the second toe. The deviation can be so great that the big toe under-rides the second toe. A large bump appears clinically on the medial aspect of the first MTPJ. Pain can be experienced at the bump or in the joint (MTPJ) causing a poor quality and limitations of motion. The simple act of wearing shoes can be excruciation but does not actually cause the deformity, it only exacerbates it. Hallux valgus can be a progressive deformity causing limitation of big toe motion, degeneration of the big toe joint, and pain during ambulation.

Bunions are generally not inherited, but certain foot types are that may lead to hallux valgus at some point. Ligamentous laxity, a hypermobile foot, a foot that pronates (flattens) excessively, or arthritides (such as rheumatoid or gout) are all conditions that may predispose a person to develop hallux valgus.

Conservative approaches to treatment are aimed at decreasing symptoms and slowing progression. A brief course of anti-inflammatories, padding, changing shoe styles, and orthotics are all modalities that may decrease pain and slow the progression, but will not make the “bump” go away. Once the hallux has deviated in position and changes in joint congruity have occurred, surgical reconstruction is the only definitive treatment that can change the clinical appearance. The extent of the surgical reconstruction depends on the complexity of the deformity, patient age, health status, degree of symptoms, and concomitant pathology.

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Neuroma or “Pinched Nerve”


A neuroma is a benign growth of nerve tissue that can occur to any of the nerves in the foot. Forefoot nerves are more susceptible to this process because of their specific location. The ball of the forefoot undergoes a great deal of motion as the toes flex and extend. There is also a limited amount of space between the metatarsal heads through which the forefoot nerves travel before dividing into digital nerves to provide sensation to the toes. The increased motion and limited space of the forefoot can cause the nerves to be stretched, tethered, or compressed; all of which can start the process of neuroma formation. Certain activities that require an increase in forefoot motion and stress (i.e., dance, baseball catcher) or occupations that require squatting (i.e., tile or carpet layer) can also aggravate the forefoot nerves leading to possible neuroma development. Acute or repetitive trauma to any nerve in the foot can lead to perineural fibrosis (scar tissue surrounding nerve) or neuroma formation.

By far, the most common site in the foot for a neuroma to occur is between the third and fourth toes in an area called the third intermetatarsal space. A neuroma in this region affects the third common plantar digital nerve and is commonly referred to as a “Morton’s Neuroma”.The region of nerve undergoing neuroma formation appears thickened and swollen. Patients complain of a lump under the forefoot, the sensation of a sock rolled up in the area, numb toes, shooting electrical pain, or pain and discomfort so great that, at times, they must take off their shoes and massage their forefoot. The condition is usually progressive.

Conservative treatment consists of orthoses with metatarsal accommodations, injections of local anesthetic mixed with a steroid, proper selection of shoes, and/or a short course of physical therapy or anti-inflammatories to reduce perineural fibrosis and swelling.Surgical excision, either from the dorsal or plantar approach, is recommended only after failed conservative care. Procedures are usually performed as an outpatient.

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