Gouty tophi

Gouty Tophi, singular tophus, are an ugly, deforming, painful nodular mass of uric acid crystals that may be deposited in different soft tissue areas of the body. They are a typical sign of Gout, a very treatable medical condition which is seen not infrequently in the chiropractic office.

The word tophus comes from the Greek word 'tophos' meaning a porous volcanic stone. Gout is but one of over 100 arthritic conditions.

Gouty tophi on the hand.

Healthy living tips

There is currently an explosive outbreak of gout in the western world, probably related to the poor Western diet, responsible for so many other chronic diseases also. Instead, why not visit our Healthy Living Tips page regularly for ideas about healthy food? In short, eat like grandmother did, and not what your mother taught you. It's her generation that saw the move away from natural, healthy foods, to the junk churned out, at great cost I might add, that proliferates on the supermarket shelves.

These horrid lumps and bumps can appear in any of the soft tissues, but usually they form in the foot, elbow or fingers. They can also form in the ear and in the spine causing back pain.

Know you have gout periodically? Make sure you tell your chiropractor.

Gouty tophi

Gouty tophi on the elbow.

Treatment @ chiropractic help

The most usual treatment of gout is a course of antiinflammatory drugs when the pain and inflammation begin. In more difficult cases, daily medicine may be needed.

Instead, perhaps consider a diet rich in fruit, salad and veg. That will also lower your cholesterol, fix your constipation and a host of other diet related diseases.

Gouty tophi on the ear.


Tabbouleh bulgar wheat is a delicious healthy Lebanese parsley, tomato and mint dish. The first step to dealing with gouty tophi is to dramatically increase the fibre in your diet. This increases excretion of both waste products and substances like cholesterol that you have eaten. Tabbouleh bulgar wheat is a traditional Mediterranean dish.

On a personal note, I suffer myself periodically from episodes of gout. The most recent, just after Christmas when we indulged in much ham, turkey and roast beef, was highly predictable. Significantly, simultaneously I also had pain in the fingers and lower back pain. A visit to the chiropractor is not what was called for. Rather a visit to the fruit and veg market.  And staying away from the butchery.

Only one episode has resulted in severe pain and swelling in the great toe, and required anti inflammatory drugs for a few days.

Interestingly, beer is thought to be one of the worst culprits, and over the years I have indeed drunk too much beer. What is odd, though, is that it was giving up beer permanently that provoked the first episode of gout. I have never had gout whilst a beer drinker. Beer makes a good servant but a bad master.

I have a strong suspicion that it was cutting down on my liquid intake when I quit beer that was the villain of the peace. Now I drink a lot more water, teas and have only small amounts of fruit juices, always freshly squeezed.

Usually, a couple of doses of alkalising drops, and cutting back hard on red meat for a week does the trick.

What keeps the gout at bay, in my case is Helen's 15 euro salad. The alkalising effect of what our friends call our rabbit food works like a charm. And it's they of course that are are described in the literature as the phytochemical foods rich in antioxidants that prevent dread disease.

Gouty tophi, don't let them happen. Make the changes in your diet that are necessary, or in time you will suffer the severe disability and pain of advanced degenerative arthritis in your joints. The cure, as the bard reminds us, oft lies in our own hands.

Water is certainly part of the solution, in the minds of some the biggest part. So, drink more water, up to eight glasses per day, though weak teas, with no sugar or milk, using fresh fruit for sweetening, is fine.

There are many confusing dietary recommendations. For example, avoid foods high in purines which includes all protein foods including legumes. However, we can't survive without dietary protein.

Plus gout and obesity go hand in hand, and most diets today recommend a move away from starches, together with a moderate increase in protein.

You're damned if you do, and you're damned if you don't!

My advice is to eat less red meat, more legumes, but keep a gout diary. Often you can directly relate an attack of gout to some indiscretion.

Personally, I eat a huge amount of hummus, made of chickpeas, and green beans, and I can't say I've noticed any connection with gout.

There is some research suggesting that high doses of vitamin C may help, though that dose is likely to have other side effects. How about a long glass of freshly squeezed orange juice, topped up with water. Not OJ, that's a junk food with a very high glycemic index. Avoid.

Orange juice facts tells the story.

The omega 6 to omega 3 ratio is important in all the arthridities. Change from seed oils to olive oil and increase your anti inflammatory omega 3.

Beer makes a good servant but a very bad master.

Useful links

Immobilisation arthritis is another much more common cause of joint pain.

  1. Chiropractic Help
  2. Foot pain
  3. Gouty tophi

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

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Interesting questions from visitors

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Greetings, Dr B.

You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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Knowing that up to 70 percent of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there is a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong. Give plenty of detail if you want a sensible reply.

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