Gout
Classic Martel’s Sign or Rat Bite Sign resulting from chronic gout attacks. 1st MPJ.
Gout…..Uric Acid. This painful arthritis occurs when small sharp uric acid crystals infiltrate a joint. This is the result of hyperproduction or under excretion of uric acid, which is a byproduct of purine breakdown. Purines are chemicals found in many foods and beverages, when they are broken down they produce uric acid. While alcohol, red meats and seafood are commonly known to cause gout, there are a plethora of other foods and beverages which can cause gout as well. Everyone responds differently to foods/beverages and some people experience gout attacks as a result of substances which rarely cause gout in the general population.
While gout can occur in any joint, it primarily affects the 1st metatarsophalangeal joint (big toe joint). The 1st MPJ is one of the most commonly injured/arthritic/inflamed joints in the foot, which means that joint often experiences hyperperfusion and swelling. When the body has excess uric acid in the blood (hyperuricemia) and there is increased blood flow into/around the 1st MPJ, naturally the uric acid crystals deposit within that joint. This deposition of uric acid into the joint presents as redness, swelling and exquisite pain/tenderness even with the lightest touch/movement, including the bed sheets simply resting on the toe.
If enough gout attacks occur in a joint it can cause joint destruction including something called a Martel sign or a “rat bite” sign (pictured above). For this reason it is important for patients who regularly suffer from gout to discover the cause of the attack so they can prevent future attacks and hence prevent joint destruction and future pain.
While there are medications which help prevent or alleviate gout attacks, these medications can cause nasty side effects and ultimately may prove unnecessary if the cause of the hyperuricemia can be discovered. As such, if you experience gout attacks with any regularity, I strongly advise retrospectively journaling your food/beverage consumption 12-36 hours after onset of an attack. After journaling for a few attacks, it is common for patients to discover the unknown culprit causing the increased uric acid and subsequent pain.