[s mags]

Sesamoid Fracture or Gout?

I just want to relate my recent experience and see what others think or what light they may be able to shed on this situation. Because I had a weird first brush with gout and fractured sesamoid.

I am a 45-year-old active male in good shape with decent eating habits. I drink socially, a fair amount of that is beer. I woke up about 6 weeks ago with some pain and discomfort in my big toe. I wasn’t paying very close attention to it. But my impression at the time was that I thought I had slept on it funny. Maybe did something like hyper extend it in my sleep. Or slept with it bent back for a length of time that caused me to wake up sore. It wasn’t incredibly painful though, so I didn’t think too much of it. In fact, I sort of figured the best thing to do was to work and stretch the toe as I normally would. That day I did the orbital machine at the gym as well as some shadowboxing and weightlifting, all of which put pressure on the toe.

I went out for dinner that night and had a few beers (not unusual) and the toe was stiffening up and a bit sore.
I went to bed that night and maybe an hour or two after I fell asleep, I was awoken by excruciating pain. Throbbing, sensitivity etc. I took some anti-inflammatories and iced it. But could barely sleep.
I hobbled to work the next day and taped my toe to restrict the movement of the joint for, what seemed to me, maybe some sort of turf toe.

I did some glancing at gout as a cause. But dismissed it pretty quickly, thinking I was not really a candidate for that and also thinking that fast onset and severe pain, was not consistent with gout. I was wrong about both of those things.

But the taping helped and the pain subsided over the next few weeks. I was able to do yoga and box and was in a little discomfort but not bad pain.
Maybe 5 or 6 weeks after that episode (after 2 long intense bike rides and another workout) the toe pain came back, and I was again having trouble walking. At this point, I found a podiatrist and went in for an appointment.

He took an X-ray which didn’t show anything and said his hunch was that it was gout. But that he would send me for both a blood test and an MRI. I also was given a 5 or 6-day pack of prednisone, an anti-inflammatory steroid.

The steroid cleared the pain up very quickly. I was hopping around barefoot and everything seemed good. The blood test came back before I could schedule an MRI and the uric acid read 8.1 which all seemed to point to a gout attack.
I started wrapping my head around this and immediately cut out several foods as well as making certain I was drinking over 100oz of water a day as well as adding baking soda and apple cider vinegar to my intake.

When the course of prednisone was over, the pain came back with a little swelling. I was able to get the MRI, which showed a fracture on the medial sesamoid.
So now I’m dealing with healing that but am pretty unclear about exactly what I’m dealing with overall. There was no specific incident I can recall in which I feel like I caused the fracture but there is a fracture nonetheless.
Is it possible I fractured the toe and the inflammation from that led to a gout attack? Would a gout attack have weakened the bone and the fracture was secondary?
Is it possible I have 8.1 uric acid but didn’t actually have a gout attack at all?
I’m curious if anyone else has experienced anything similar or has any tips on how to figure this out.

Thanks

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