Question: Hi,
I am 28 years old, male, a competitive swimmer and in good health. Blood pressure typically at 120/80, general check ups indicates that i am healthy. Creatine and other blood hematology test results seem alright.
I have got pain at the accessory navicular region, which started with an attack/flare very similar to gout. Afterwhich, it slowly recovered and another attack/flare occured. The right foot accessory navicular suffered the attacks on end October, end November, early January. The left foot accessory navicular suffered an attack at mid december. Its now mainly pain on weight bearing, with occasional non-voluntarily muscle/tendon twitches, mostly occuring along the path of posterial tibial tendon, sometimes at the ankle, other times at the forefoot (around the 1st cuneiform).
Nsaids (indomethacin) is helpful during a flare, but not for the pain (on weight bearing) after the flare. Indomethacin, celebrex, colchicine does not help the latter. During the flare, its impossible to bear weight due to excruciating pain. After the flare, it is mainly pain on foot landing whilst walking slowly. The pain increases in intensity with distance, and at about 200-400m, the pain would be excruciating. The pain will then die down with rest. First few steps typically encounter stress but not pain.
MRI indicates bone oedema at the site of accessory navicular and navicular synchondrosis. The reports states that it is in line with symptomatic accessory navicular. PTT and other tendons/ligaments is preserved. All other bones in good shape.
Sometimes while resting, i find false pain around the foot, lasting for split-2 seconds. Sometimes at the cineiform, other times at the arch, XXXXXXX ankle. Each time i touch the pain site immediately after the pain is detected, there is no pain. I am unable to replicate it. It only occur on rest.
Prior to the first flare attack, i was indeed eating pretty XXXXXXX food and walking around alot. I stood and walked for approximately 15 hours the day before. No running, no jumping, no trauma. Wearing custom orthotics, but this insole presses very hard against the pain site, and i am wearing a off the shelf overproner shoe, the XXXXXXX beast.
My question would be:
1) Can this be gout? ESR and CPR readings are low, but uric acid is 7-8.2mg/dl. I understand that my uric acid is on the high side. No synovial fluid sample was taken because the doctor i saw claimed that there is no synovial fluid @ the pain site. The pain site is not red nor swollen. Excruciating pain when pressed during a flare. Pain when pressed otherwise.
2) Can this be a nerve problem? Can the accessory navicular somehow catch or pinch the medial plantar nerve/other nerves when my arch collapse? I do have collapsible flat foot.
3) Is it possible for gout to develop at the accessory navicular, or to cause bone oedema at the accessory navicular-navicular synchondrosis?
4) What in your opinion, am i suffering from? I am mostly home bound these days, as i can't really walk. Please help!!!