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Hi,
Have recently come across about three different cases of ulcers with small chalky white crystals present. Each patient has been referred for blood tests to check for gout.
One GP's response was that you cannot diagnose gout from the appearance of the foot, or from the presence of crystals, and hence refused to carry out a blood test.
Each case has not been particularly painful, but the recurrent crystals are preventing healing.

So, advice please on diagnosis, treatment and management.

Thanks in advance.

Tell the MD to get stuffed! White discoloration in a wound, especially at the 1st mpj is almost always from uric acid until proved otherwise.

Bruce Williams, D.P.M.

Strange attitude from the GP!

If (s)he holds that you cannot Dx gout from the appearance of crystals in a wound, then you most certainly can from blood chemistry. Ignore the G.P., send the patient for bloods at your local private hospital and likewise take a sample of the crystals and send for histo-path analysis.

When the results come in +ve you can then enjoy yourself writing a nice 'humble' letter to the G.P. with a copy of the reports.

All the best

Bill Liggins

Other threads here on gout:
Reason for gout in more peripheral joints
Gout can affect the nose
Test your knowledge on gout
The latest on gout
Performing arthrocentisis for crystal deposition disease

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The physician said he "Cannot diagnose Gout from the appearance of the foot".......
well, I would believe him........ of course, the rest of us can.
Dr. Steve

agree definetly sounds like gout
had similiar reaction from a gp previously got a x ray and there was gouty destruction ,the gp changed his attitude
i have found that the best for healing this type of ulcer is idosorb with lyofoam changed evey 3 days. bathe with a weak solution of bicarb soda instead of saline. got this from a conference melb 84 i think its in the abstracts

Foot = gouty
GP = twit

If you cannot diagnose gout from the appearance of the foot surely thats a damn good reason to do a blood test. Thats like saying you can't tell somebodies blood sugar by examining their hair so there's no point in doing an HbA1c!*

Regards
Robert

*Or indeed
"if you don't know why I'm angry with you..."
say it with me boys...
"THERES NO POINT ME TELLING YOU!"
Obviously you need two proper fully grown X chromasomes for that to make sense. Our runty shrivled little Y chromasomes just don't work as well.

Are there any more articles on treatment on gout ulcers?

I'm really keen to know more about it beside what dsfeet has suggested.

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Miss Gangrene

Don't forget about the possibility of it being Pseudogout (Calcium Pyrophosphate Dihydrate deposition diesease) as it can present similar to gout, with white tophy. Pathology testing of crystals is a good idea for diagnosis.
A blood test for gout or pseudogout may often be negative as the condition may not be in its "active" stages even though joint destructive process has already occured (I have seen this a number of times). In other words experience may tell you that its gout, but a blood test may not back you up.
Correct diagnosis and treatment of both conditions is essential d/t associated pain of acute attacks and joint destruction as well as associated skin pathology.