Other Disorders of the Lower Limbs

Gouty Arthritis
Gout is a metabolic disease and often runs in families. It is associated with abnormal accumulation of urates in the body and characterized early by a recurring acute arthritis, usually mono–articular (single joint involvement) and later on, deforming chronic arthritis. About 90% of patients of Gout are men, usually of over 30 years of age.In acute Gouty Arthritis involvement of peripheral joint, mainly metatarsal joint of the big toe is common.

It becomes so much red, hot, swollen and tender that even touching of bed clothes may become agonizing. The attack is insidious, sometimes explosively sudden and may even wake up the patient from sleep.

After a few days, the symptoms and signs usually disappear followed by peeling of skin overlying the affected joint. Attacks may recur after weeks, months or even years.

In chronic Gouty Arthritis, recurrent attacks of Gout result in progressive erosion of the cartilage and bone associated with the formation of tophi (urate crystal deposition) causing considerable disability with osteoarthritis super–imposed over it. Tophi are nodular thickenings which occur in tendon sheaths, bursa and cartilage of the ear. Renal Calculi (stones in the kidneys) occur in 10% of Gout sufferers. The uric acid level in the blood would be high.

Treatment

• Treatments used for osteoarthritis of knees and ankles also hold good for Gouty Arthritis.
• Diet – To help reduce high blood uric acid level following items should be avoided.
• Meat, fish and other non–vegetarian food.
• Vegetables such as beans, peas, cauliflower, mushrooms and spinach.
• Coffee, tea, chocolate and alcohol.
• Reduce whole grains, legumes, milk, cheese, butter and sugar.
• Drinking of plenty of water helps in excretion of uric acid.

Low Backache

Most people suffer from back pain at some time or other in their lives. This is the penalty to be paid for assuming wrong posture. Back pain is second only to headache among the leading causes of pain. Most of the back pain sufferers otherwise lead a normal life.

Though drugs provide relief from severe pain or relax the muscles, they are not a cure for backache. If they are overused, they may become a habit and actually increase the recurrence of pain.

Recurring back pain often results in devitalization, fatigue and depression. Recurrence of back pain is quite common amongst the diagnosed low back sufferers. Psychological stress, a known factor in precipitating back pains, is responsible for stiffness of the back muscles which then causes painful spasm resulting in back pain.

Apart from overuse of the spine, stress and sedentary habits, the other causes of back pain include weakened back muscles, protruded abdomen which pulls back muscles placing extra stress on the back, over exercising such as jogging, aerobics etc. and obesity. The aging process also contributes to back pain.

In fact, about 80–85% of back pain is due to muscular weakness, stress etc., and 15–20% as a result of structural defect or disease such as osteoarthritis, prolapsed inter–vertebral disc, lumbar spondylosis, spinal canal stenosis, facet joint syndrome and spondylolisthesis.

Compared with standing, sitting increases the pressure by 40%, while lying down decreases it to 25% of the pressure exerted on standing. Sneezing, laughing and coughing also increase disc pressure and hence aggravates the back pain.