Feet: Gout and Pseudogout

Several years ago I attempted the Southwest Couloir route on Mount Huntington in Alaska in some oversized Koflach boots. After I'd led many pitches of steep ice my left toe began cramping and hurting so badly I could no longer frontpoint and was basically climbing the last pitches with only my right foot.

By Rock and Ice | February 2nd, 2010

Several years ago I attempted the Southwest Couloir route on Mount Huntington in Alaska in some oversized Koflach boots. After I’d led many pitches of steep ice my left toe began cramping and hurting so badly I could no longer frontpoint and was basically climbing the last pitches with only my right foot. A few years later, out of the blue, I had an incredibly painful pseudogout attack in this same toe. The doctors had no explanation, as I’m not the typical candidate for gout (overweight, bad diet, older). Could this gout attack be related to that episode on Huntington?

Dick Stone | Boulder, CO

I am going to assume you have pseudogout and not gout, and that this has been diagnosed from a synovial fluid sample. Though the two conditions have some common ground, principally some gnarly crystal formations within the joint, the terms are not interchangeable.

One of the primary causes of pseudogout is trauma. Obdurately booting your big toe into a behemoth popsicle would clearly qualify, though it would not be a given that this was the original cause. Old crustiness, genetic anomalies and a side note of metabolic misbehavior all correlate with pseudogout.

Claiming a thyroid problem might actually be reasonable®even a parathyroid problem, just to sound both legitimate and super-dooper. Excessive iron in your blood (hemochromatosis), kidney disease, the medicine Didronel (etidronate disodium), and even lead poisoning have been linked to pseudogout, along with a bevy of other factors. Notably, the garden-variety osteoarthritis is a precipitating factor. Translation: in all likelihood we can’t discern the cause, but we will give a fancy name, idiopathic, to continue the subterfuge of authority.

Typically, the offending joint is red, hot and pissed off. Fever, chills and tiredness (forget this last one if you are a lazy climbing bum and/or smoke too much pot) are also possible. Septic arthritis is a medical emergency, and must always be considered.

There is no specific therapeutic regimen to treat the underlying cause of pseudogout. Bummer. Anti-inflammatory medication and a couple of weeks of rest is about as complex as it gets. Pain is a great restrainer: too sore to get your shoe on? Don’t put your shoe on. If you are irresistably touched by the process of climbing (read: addicted), go to Rifle. After suffering the 2-cool-4-skool posse, the I-can-do-one-arm’ers, why-can’t-I-climb gang, and the Beta Brigade who insist on blowing your onsight, you won’t feel much like climbing for at least a few weeks.

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