As a Philadelphia podiatrist at Healthmark Foot and Ankle Associates, I’ve seen my fair share of gout cases. Gout, often dubbed the “Rich Man’s Disease,” has plagued humanity for centuries, yet its prevalence continues to rise, affecting millions worldwide. But beyond the painful swelling and redness in the joints, gout holds deeper implications that demand our attention, especially in the realm of podiatry and beyond.
Let’s go back to basics.
When confronted with a patient presenting with symptoms suggestive of gout, it’s imperative to adhere to the fundamentals of medical care. This means conducting thorough bloodwork, including assessing uric acid levels, ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), and CMP (Comprehensive Metabolic Panel). These general markers provide crucial insights into the patient’s systemic health and help guide treatment decisions.
Why is this meticulous approach so vital?
Gout is often not a surgical issue—it’s metabolic and systemic. Surgery should be a last resort, preceded by comprehensive systemic control. After all, the foot is intricately connected to the rest of the body; addressing underlying metabolic imbalances is paramount to long-term management and preventing recurrent gout attacks.
Consider the scenario of a perioperative patient. Surgery places significant stress on the body, necessitating adjustments in medication and hydration levels, and postoperative patients can see a rise in uric acid levels. Overlooking the importance of controlling uric acid levels pre-operatively can spell trouble. Post-surgical gout flare-ups are not uncommon, often attributed to medication changes, inadequate hydration, or simply the physiological stress of the procedure itself.
This underscores the need for heightened awareness during wellness or pre-operative visits. Yet, it’s disheartening to observe that many overlook the significance of monitoring uric acid levels during these crucial junctures. We must bridge this gap in understanding, recognizing that gout can rear its head anytime, anywhere, especially after surgical interventions.
How do we address the educational deficit?
It begins with our medical and podiatric schools. Podiatrists are often the first to encounter gout and many other lower extremity issues. Therefore, it’s imperative to integrate comprehensive education on gout management into podiatric curricula. This extends beyond the classroom; continuous medical education (CME) seminars and workshops should prioritize gout education to equip practitioners with the latest insights and strategies.
More than this, how can podiatrists become more knowledgeable about gout? Podiatry students need to be educated more about medication. As the first to often see the problem, understanding the medications a patient may be on that could be exacerbating a gout flare-up is crucial to patient care and treatment.
As podiatrists, we also need to be aware of Pseudogout, clinically known as calcium pyrophosphate deposition (CPPD) disease. This disease shares several similarities with gout, including acute inflammatory arthritis and crystal deposition in the joints. However, the culprit crystals in pseudogout are calcium pyrophosphate (CPP) rather than the uric acid crystals seen in gout. This fundamental distinction dictates treatment approaches and underscores the need for accurate diagnosis and tailored management strategies.
Unlike gout, where needle-shaped urate crystals are visualized under polarized light microscopy, pseudogout reveals rhomboid-shaped CPP crystals—a crucial diagnostic clue guiding appropriate management.
The gout care team – it’s not just a foot thing
Our responsibilities don’t end there. Podiatrists must be integral members of the broader care team for patients battling gout. Gout doesn’t discriminate—it affects multiple body parts and organs, transcending the confines of the foot. Hence, podiatrists must collaborate closely with rheumatologists, endocrinologists, and other healthcare professionals to deliver holistic care.
To achieve this, greater emphasis should be placed on interdisciplinary collaboration and education. Nurse practitioners, physician assistants (PAs), and other allied healthcare professionals must receive comprehensive training on gout management and potential causes. We can optimize outcomes for patients grappling with this debilitating condition by fostering a cohesive care environment.
Gout is a multifaceted challenge that demands a multidisciplinary approach. As medical experts, we must champion systemic control, emphasizing the importance of pre-operative optimization and continuous monitoring of uric acid levels. By bolstering our educational efforts and enhancing collaboration with other healthcare providers, we can truly make a difference in the lives of those affected by gout. After all, it’s not just a foot thing—it’s a holistic endeavor aimed at restoring health and well-being.
