Many elderly patients understand the importance of properly taking care of their feet on a daily basis. This is necessary in possibly preventing unwanted foot conditions which may include ingrown toenails and cracked heels. The feet may change size as the aging process occurs, and it is suggested to measure them regularly to determine the correct shoe size. Research has shown it is important to wear socks that are not too tight at the top, and this can be helpful in allowing normal blood flow. Additionally, when the toes are frequently pointed and flexed, it may help the plantar fascia maintain its length. Stretching the feet can be beneficial in reducing existing muscle tension, which may prevent injuries. If you would like additional information about how to take care of elderly feet, it is suggested that you speak to a podiatrist.
Proper foot care is something many older adults forget to consider. If you have any concerns about your feet and ankles, contact Dr. Carl Ginsberg from Pennsylvania. Our doctor can provide the care you need to keep you pain-free and on your feet.
The Elderly and Their Feet
As we age we start to notice many changes in our body, but the elder population may not notice them right away. Medical conditions may prevent the elderly to take notice of their foot health right away. Poor vision is a lead contributor to not taking action for the elderly.
Common Conditions
- Neuropathy – can reduce feeling in the feet and can hide many life-threatening medical conditions.
- Reduced flexibility – prevents the ability of proper toenail trimming, and foot cleaning. If left untreated, it may lead to further medical issues.
- Foot sores – amongst the older population can be serious before they are discovered. Some of the problematic conditions they may face are:
- Gouging toenails affecting nearby toe
- Shoes that don’t fit properly
- Pressure sores
- Loss of circulation in legs & feet
- Edema & swelling of feet and ankles
Susceptible Infections
Diabetes and poor circulation can cause general loss of sensitivity over the years, turning a simple cut into a serious issue.
If you have any questions please feel free to contact our office located in Jenkintown, PA . We offer the newest diagnostic and treatment technologies for all your foot and ankle needs.
Read more about Taking Care of Elderly FeetThe pain and discomfort that often accompanies the medical condition that is known as gout can be described as severe and intense. It is considered to be a form of arthritis, and typically affects the joints surrounding the big toe. It is generally caused by elevated uric acid levels in the blood, and can develop from eating foods that have high purine levels. These types of food can consist of shellfish, red meat, and sugary drinks. Additionally, genetic factors may play a significant role in developing gout. Mild relief may be found when joint pain is controlled, and this may be accomplished by taking an anti-inflammatory medication. Painful gout attacks may be avoided when a healthy food plan is implemented. This can also include limiting alcoholic beverages and losing excess weight. If you suffer from gout, it is strongly suggested that you consult with a podiatrist who can help you to manage this condition.
Gout is a painful condition that can be treated. If you are seeking treatment, contact Dr. Carl Ginsberg from Pennsylvania. Our doctor will treat your foot and ankle needs.
What Is Gout?
Gout is a form of arthritis that is characterized by sudden, severe attacks of pain, redness, and tenderness in the joints. The condition usually affects the joint at the base of the big toe. A gout attack can occur at any random time, such as the middle of the night while you are asleep.
Symptoms
- Intense Joint Pain - Usually around the large joint of your big toe, and it most severe within the first four to twelve hours
- Lingering Discomfort - Joint discomfort may last from a few days to a few weeks
- Inflammation and Redness -Affected joints may become swollen, tender, warm and red
- Limited Range of Motion - May experience a decrease in joint mobility
Risk Factors
- Genetics - If family members have gout, you’re more likely to have it
- Medications - Diuretic medications can raise uric acid levels
- Gender/Age - Gout is more common in men until the age of 60. It is believed that estrogen protects women until that point
- Diet - Eating red meat and shellfish increases your risk
- Alcohol - Having more than two alcoholic drinks per day increases your risk
- Obesity - Obese people are at a higher risk for gout
Prior to visiting your podiatrist to receive treatment for gout, there are a few things you should do beforehand. If you have gout you should write down your symptoms--including when they started and how often you experience them, important medical information you may have, and any questions you may have. Writing down these three things will help your podiatrist in assessing your specific situation so that he or she may provide the best route of treatment for you.
If you have any questions, please feel free to contact our office located in Jenkintown, PA . We offer the newest diagnostic and treatment technologies for all your foot care needs.
Read more about Everything You Need to Know About GoutOne of the injuries that many ballet dancers endure are ingrown toenails. It can occur as a result of balancing on the tips of the toes for the majority of the dance, and can cause severe pain and discomfort. The noticeable symptoms of this ailment often include the sides of the nail growing into the surrounding skin, and it may often be red and inflamed. Common causes for ballet dancers to develop ingrown toenails can include dancing for hours at a time during rehearsals and performances. Additionally, if the nails are trimmed incorrectly, this may cause the condition to develop. There are methods that can be implemented which may prevent ingrown toenails from forming. These can include trimming the nails straight across the toe, and keeping the toes and feet clean. If you have an ingrown toenail, it is suggested to speak with a podiatrist who can treat this condition and can help you to avoid an infection from developing.
Ingrown toenails can become painful if they are not treated properly. For more information about ingrown toenails, contact Dr. Carl Ginsberg of Pennsylvania. Our doctor can provide the care you need to keep you pain-free and on your feet.
Ingrown Toenails
Ingrown toenails occur when a toenail grows sideways into the bed of the nail, causing pain, swelling, and possibly infection.
Causes
- Bacterial infections
- Improper nail cutting such as cutting it too short or not straight across
- Trauma to the toe, such as stubbing, which causes the nail to grow back irregularly
- Ill-fitting shoes that bunch the toes too close together
- Genetic predisposition
Prevention
Because ingrown toenails are not something found outside of shoe-wearing cultures, going barefoot as often as possible will decrease the likeliness of developing ingrown toenails. Wearing proper fitting shoes and using proper cutting techniques will also help decrease your risk of developing ingrown toenails.
Treatment
Ingrown toenails are a very treatable foot condition. In minor cases, soaking the affected area in salt or antibacterial soaps will not only help with the ingrown nail itself, but also help prevent any infections from occurring. In more severe cases, surgery is an option. In either case, speaking to your podiatrist about this condition will help you get a better understanding of specific treatment options that are right for you.
If you have any questions please feel free to contact our office located in Jenkintown, PA . We offer the newest diagnostic and treatment technologies for all your foot and ankle needs.
Read more about Ingrown ToenailsA common symptom of neuropathy is numbing and tingling sensations in the hands and feet. It may occur as a result of nerve damage that can come from having diabetes, and can cause severe pain and discomfort. Additional symptoms often include cramps that are felt in the calf muscles, loss of balance, and weakness in the feet. It may be difficult to walk alone, and performing daily activities may be hard to accomplish. It can be beneficial to add safety measures in your home which include installing grab bars in the shower and bathroom areas, and it may also help to increase lighting. Effective treatment options can include incorporating nutritional supplements as part of a healthy eating pattern, and performing light exercise routines. If you have any symptoms of neuropathy, it is strongly suggested that you consult with a podiatrist who can guide you toward the correct treatment.
Neuropathy
Neuropathy can be a potentially serious condition, especially if it is left undiagnosed. If you have any concerns that you may be experiencing nerve loss in your feet, consult with Dr. Carl Ginsberg from Pennsylvania. Our doctor will assess your condition and provide you with quality foot and ankle treatment for neuropathy.
What Is Neuropathy?
Neuropathy is a condition that leads to damage to the nerves in the body. Peripheral neuropathy, or neuropathy that affects your peripheral nervous system, usually occurs in the feet. Neuropathy can be triggered by a number of different causes. Such causes include diabetes, infections, cancers, disorders, and toxic substances.
Symptoms of Neuropathy Include:
- Numbness
- Sensation loss
- Prickling and tingling sensations
- Throbbing, freezing, burning pains
- Muscle weakness
Those with diabetes are at serious risk due to being unable to feel an ulcer on their feet. Diabetics usually also suffer from poor blood circulation. This can lead to the wound not healing, infections occurring, and the limb may have to be amputated.
Treatment
To treat neuropathy in the foot, podiatrists will first diagnose the cause of the neuropathy. Figuring out the underlying cause of the neuropathy will allow the podiatrist to prescribe the best treatment, whether it be caused by diabetes, toxic substance exposure, infection, etc. If the nerve has not died, then it’s possible that sensation may be able to return to the foot.
Pain medication may be issued for pain. Electrical nerve stimulation can be used to stimulate nerves. If the neuropathy is caused from pressure on the nerves, then surgery may be necessary.
If you have any questions, please feel free to contact our office located in Jenkintown, PA . We offer the newest diagnostic and treatment technologies for all your foot care needs.
Read more about NeuropathyMany patients who experience a variety of foot conditions find it beneficial to wear custom-made orthotics. These types of insoles can provide support, and may be helpful in correcting abnormal walking styles. They are constructed after an impression of the foot is taken using a 3-D laser scan, or a plastic mold. The patient will try them on, and adjustments can be made to produce maximum results. There are several foot conditions that can improve from wearing orthotics, which may include plantar fasciitis, bunions, and rheumatoid arthritis. If you would like additional information about the advantages of wearing orthotics, it is suggested that you schedule a consultation with a podiatrist.
If you are having discomfort in your feet and would like to try orthotics, contact Dr. Carl Ginsberg from Pennsylvania. Our doctor can provide the care you need to keep you pain-free and on your feet.
What Are Orthotics?
Orthotics are inserts you can place into your shoes to help with a variety of foot problems such as flat feet or foot pain. Orthotics provide relief and comfort for minor foot and heel pain but can’t correct serious biomechanical problems in your feet.
Over-the-Counter Inserts
Orthotics come in a wide variety of over-the-counter inserts that are used to treat foot pain, heel pain, and minor problems. For example, arch supports can be inserted into your shoes to help correct overarched or flat feet, while gel insoles are often used because they provide comfort and relief from foot and heel pain by alleviating pressure.
Prescription Orthotics
If over-the-counter inserts don’t work for you or if you have a more severe foot concern, it is possible to have your podiatrist prescribe custom orthotics. These high-quality inserts are designed to treat problems such as abnormal motion, plantar fasciitis, and severe forms of heel pain. They can even be used to help patients suffering from diabetes by treating foot ulcers and painful calluses and are usually molded to your feet individually, which allows them to provide full support and comfort.
If you are experiencing minor to severe foot or heel pain, it’s recommended to speak with your podiatrist about the possibilities of using orthotics. A podiatrist can determine which type of orthotic is right for you and allow you to take the first steps towards being pain-free.
If you have any questions please contact our office located in Jenkintown, PA . We offer the newest diagnostic and treatment technologies for all your foot and ankle needs.
Read more about Ankle Foot Orthotics for AthletesResearch has indicated that there are several forms of heel pain. The most common type is referred to as plantar fasciitis, and this occurs as a result of an inflamed plantar fascia. This is the band of tissue that is located on the sole of the foot, connecting the heel to the toes. Heel bursitis is a condition where pain is felt in the middle of the heel, and can develop as a result of falling from an extended height. Young children who participate in sporting activities may develop Sever’s disease, and this may develop from an inflamed Achilles tendon. Many patients will experience heel pain at some point in their lives, and there are methods to managing the pain and discomfort. If you have any type of heel pain, it is advised to consult with a podiatrist who will perform a proper diagnosis, and begin the correct treatment.
Many people suffer from bouts of heel pain. For more information, contact Dr. Carl Ginsberg of Pennsylvania. Our doctor can provide the care you need to keep you pain-free and on your feet.
Causes of Heel Pain
Heel pain is often associated with plantar fasciitis. The plantar fascia is a band of tissues that extends along the bottom of the foot. A rip or tear in this ligament can cause inflammation of the tissue.
Achilles tendonitis is another cause of heel pain. Inflammation of the Achilles tendon will cause pain from fractures and muscle tearing. Lack of flexibility is also another symptom.
Heel spurs are another cause of pain. When the tissues of the plantar fascia undergo a great deal of stress, it can lead to ligament separation from the heel bone, causing heel spurs.
Why Might Heel Pain Occur?
- Wearing ill-fitting shoes
- Wearing non-supportive shoes
- Weight change
- Excessive running
Treatments
Heel pain should be treated as soon as possible for immediate results. Keeping your feet in a stress-free environment will help. If you suffer from Achilles tendonitis or plantar fasciitis, applying ice will reduce the swelling. Stretching before an exercise like running will help the muscles. Using all these tips will help make heel pain a condition of the past.
If you have any questions please contact our office located in Jenkintown, PA . We offer the newest diagnostic and treatment technologies for all your foot and ankle needs.
Read more about Heel PainThere are ligaments that surround the cuboid bone, and if an injury should occur that affects this part of the foot, a condition that is known as cuboid syndrome may develop. You may notice pain and discomfort on the side of your foot, and it can worsen as weight is put on it. Some patients can lose the ability to move the foot, and the toes may appear swollen and weak. The most common causes of this type of injury can include twisting your ankle during a fall, or participating in sporting activities which can cause ankle pain. Additionally, this ailment can develop from wearing shoes that do not fit correctly, being overweight, or not stretching the feet before exercising. Mild relief can be found when the affected foot is elevated, and it may be beneficial to wrap the ankle with an elastic bandage that provides support. If you have pain on the side of your foot, it is suggested that you speak to a podiatrist who can properly treat this condition.
Cuboid syndrome, also known as cuboid subluxation, occurs when the joints and ligaments near the cuboid bone in the foot become torn. If you have cuboid syndrome, consult with Dr. Carl Ginsberg from Pennsylvania. Our doctor will assess your condition and provide you with quality foot and ankle treatment.
Cuboid syndrome is a common cause of lateral foot pain, which is pain on the outside of the foot. The condition may happen suddenly due to an ankle sprain, or it may develop slowly overtime from repetitive tension through the bone and surrounding structures.
Causes
The most common causes of cuboid syndrome include:
- Injury – The most common cause of this ailment is an ankle sprain.
- Repetitive Strain – Tension placed through the peroneus longus muscle from repetitive activities such as jumping and running may cause excessive traction on the bone causing it to sublux.
- Altered Foot Biomechanics – Most people suffering from cuboid subluxation have flat feet.
Symptoms
A common symptom of cuboid syndrome is pain along the outside of the foot which can be felt in the ankle and toes. This pain may create walking difficulties and may cause those with the condition to walk with a limp.
Diagnosis
Diagnosis of cuboid syndrome is often difficult, and it is often misdiagnosed. X-rays, MRIs and CT scans often fail to properly show the cuboid subluxation. Although there isn’t a specific test used to diagnose cuboid syndrome, your podiatrist will usually check if pain is felt while pressing firmly on the cuboid bone of your foot.
Treatment
Just as the range of causes varies widely, so do treatments. Some more common treatments are ice therapy, rest, exercise, taping, and orthotics.
If you have any questions, please feel free to contact our office located in Jenkintown, PA . We offer the newest diagnostic and treatment technologies for all your foot care needs.
Read more about Cuboid Syndrome
Osteoarthritis commonly affects the joints in the feet and ankles. There are many non-surgical ways to manage the pain from this ailment. For example, you can receive steroid injections at the site of the joint. Anti-inflammatory medications and pain relieving drugs are also known to help. Pads, arch supports, canes, braces or specialized orthotics could prove to be beneficial while walking and remaining active. Many patients also attend physical therapy to strengthen their feet and ankles. Additionally, losing weight may help with arthritic symptoms. One of the most essential elements of caring for arthritic feet is wearing the correct shoes. Make sure your shoes are shaped like your foot, have rubber soles, have support, fit properly and allow for flexible movement. Another helpful tip is to stretch the Achilles tendon and toes in order to minimize foot pain. If these methods are not improving osteoarthritis discomfort, surgery may be a viable option. If you have any questions about how osteoarthritis influences your feet and ankles, schedule a consultation with a podiatrist.
Arthritis can be a difficult condition to live with. If you are seeking treatment, contact Dr. Carl Ginsberg from Pennsylvania. Our doctor can provide the care you need to keep you pain-free and on your feet.
Arthritic Foot Care
Arthritis is a term that is commonly used to describe joint pain. The condition itself can occur to anyone of any age, race, or gender, and there are over 100 types of it. Nevertheless, arthritis is more commonly found in women compared to men, and it is also more prevalent in those who are overweight. The causes of arthritis vary depending on which type of arthritis you have. Osteoarthritis for example, is often caused by injury, while rheumatoid arthritis is caused by a misdirected immune system.
Symptoms
- Swelling
- Pain
- Stiffness
- Decreased Range of Motion
Arthritic symptoms range in severity, and they may come and go. Some symptoms stay the same for several years but could potentially get worse with time. Severe cases of arthritis can prevent its sufferers from performing daily activities and make walking difficult.
Risk Factors
- Occupation – Occupations requiring repetitive knee movements have been linked to osteoarthritis
- Obesity – Excess weight can contribute to osteoarthritis development
- Infection – Microbial agents can infect the joints and trigger arthritis
- Joint Injuries – Damage to joints may lead to osteoarthritis
- Age – Risk increases with age
- Gender –Most types are more common in women
- Genetics – Arthritis can be hereditary
If you suspect your arthritis is affecting your feet, it is crucial that you see a podiatrist immediately. Your doctor will be able to address your specific case and help you decide which treatment method is best for you.
If you have any questions, please feel free to contact our office located in Jenkintown, PA . We offer the newest diagnostic and treatment technologies for all your foot care needs.
Read more about How to Care for Your Arthritic FootMore...
Has your child been complaining of pain, swelling, or redness in one or both heels? Is your child very active, especially in sports such as basketball and soccer? Sever’s disease is a swelling and irritation of the growth plate in the heel. It is not actually a disease, but a heel injury. Sever’s disease happens during the growth spurt of puberty. During the growth spurt, your child’s heel bone grows faster than the muscles, tendons, and ligaments in their legs. While the best treatment is rest, your doctor may also recommend the following: ice packs on the heel every 1-2 hours for 15 minutes, gel cups or supportive shoe inserts, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for pain relief. If your child is complaining of heel pain, please contact your local podiatrist.
Sever's disease often occurs in children and teens. If your child is experiencing foot or ankle pain, see Dr. Carl Ginsberg from Pennsylvania. Our doctor can treat your child’s foot and ankle needs.
Sever’s Disease
Sever’s disease is also known as calcaneal apophysitis, which is a medical condition that causes heel pain I none or both feet. The disease is known to affect children between the ages of 8 and 14.
Sever’s disease occurs when part of the child’s heel known as the growth plate (calcaneal epiphysis) is attached to the Achilles tendon. This area can suffer injury when the muscles and tendons of the growing foot do not keep pace with bone growth. Therefore, the constant pain which one experiences at the back of the heel will make the child unable to put any weight on the heel. The child is then forced to walk on their toes.
Symptoms
Acute pain – Pain associated with Sever’s disease is usually felt in the heel when the child engages in physical activity such as walking, jumping and or running.
Highly active – Children who are very active are among the most susceptible in experiencing Sever’s disease, because of the stress and tension placed on their feet.
If you have any questions, please feel free to contact our office located in Jenkintown, PA . We offer the newest diagnostic and treatment technologies for all your foot and ankle injuries.
Read more about Sever's DiseaseThe medical condition that is referred to as tarsal tunnel syndrome, or TTS, can cause pain and discomfort on the inside of the ankle. It often occurs as a result of nerve damage, which may lead to inflammation. Patients who run or exercise for extended periods of time may gradually experience this type of nerve damage, or it may come from enduring a traumatic injury. Mild relief may be felt by gently stretching the surrounding muscles and tendons, in addition to resting and elevating the affected ankle. This may help to diminish a portion of the swelling. In severe cases, taping the ankle or wearing a brace may provide adequate support as the ankle heals. If you feel you have this condition, it is suggested to consult with a podiatrist who can offer the correct treatment options for you.
Tarsal tunnel syndrome can be very uncomfortable to live with. If you are experiencing tarsal tunnel syndrome, contact Dr. Carl Ginsberg of Pennsylvania. Our doctor can provide the care you need to keep you pain-free and on your feet.
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome, which can also be called tibial nerve dysfunction, is an uncommon condition of misfiring peripheral nerves in the foot. The tibial nerve is the peripheral nerve in the leg responsible for sensation and movement of the foot and calf muscles. In tarsal tunnel syndrome, the tibial nerve is damaged, causing problems with movement and feeling in the foot of the affected leg.
Common Cause of Tarsal Tunnel Syndrome
- Involves pressure or an injury, direct pressure on the tibial nerve for an extended period of time, sometimes caused by other body structures close by or near the knee.
- Diseases that damage nerves, including diabetes, may cause tarsal tunnel syndrome.
- At times, tarsal tunnel syndrome can appear without an obvious cause in some cases.
The Effects of Tarsal Tunnel Syndrome
- Different sensations, an afflicted person may experience pain, tingling, burning or other unusual sensations in the foot of the affected leg.
- The foot muscles, toes and ankle become weaker, and curling your toes or flexing your foot can become difficult.
- If condition worsens, infections and ulcers may develop on the foot that is experiencing the syndrome.
A physical exam of the leg can help identify the presence of tarsal tunnel syndrome. Medical tests, such as a nerve biopsy, are also used to diagnose the condition. Patients may receive physical therapy and prescriptive medication. In extreme cases, some may require surgery.
If you have any questions please feel free to contact our office located in Jenkintown, PA . We offer the newest diagnostic and treatment technologies for all your foot and ankle needs.
Read more about Treating Tarsal Tunnel SyndromeA common ailment many pregnant women complain of is swollen feet. The growing fetus exerts pressure on the uterus, and this can cause excessive swelling in the feet and ankles. This can be uncomfortable, but research has shown there are measures that can be implemented, which can help to prevent this condition. It is important to avoid standing for extended periods of time, drink plenty of fresh water, and reduce salt intake. Additionally, performing a gentle exercise routine may also help, and staying as cool as possible in hot weather may aid in reducing unwanted swelling. There is generally no reason to be concerned if edema becomes part of pregnancy life. If it becomes difficult to perform daily activities, it is suggested to consult with a podiatrist who can provide you with additional information.
Pregnant women with swollen feet can be treated with a variety of different methods that are readily available. For more information about other cures for swollen feet during pregnancy, consult with Dr. Carl Ginsberg from Pennsylvania. Our doctor will attend to all of your foot and ankle needs.
What Foot Problems Can Arise During Pregnancy?
One problem that can occur is overpronation, which occurs when the arch of the foot flattens and tends to roll inward. This can cause pain and discomfort in your heels while you’re walking or even just standing up, trying to support your baby.
Another problem is edema, or swelling in the extremities. This often affects the feet during pregnancy but tends to occur in the later stages.
How Can I Keep My Feet Healthy During Pregnancy?
- Wearing orthotics can provide extra support for the feet and help distribute weight evenly
- Minimize the amount of time spent walking barefoot
- Wear shoes with good arch support
- Wear shoes that allow for good circulation to the feet
- Elevate feet if you experience swelling
- Massage your feet
- Get regular, light exercise, such as walking, to promote blood circulation to the feet
If you have any questions please feel free to contact our office located in Jenkintown, PA . We offer the newest diagnostic and treatment technologies for all your foot and ankle needs.
Read more about Pregnancy and Foot HealthThe condition that is known as gout is considered to be a form of arthritis, and affects the joint under the big toe. Many people who suffer from this ailment often experience severe pain and stiffness, which will most likely begin during the night. Additional symptoms include extreme sensitivity when touched, as well as the joint appearing to be swollen and red. This condition occurs as a result of excess uric acid in the blood levels, which can cause crystals to form. These crystals can lodge into the joints of the body, and many patients notice symptoms of this in the big toe. Research has indicated the formation of these crystals can be caused by eating foods that have elevated levels of purines. These include shellfish, red meat, alcohol, and sugary beverages. If you are having gout attacks, it is advised to speak to a podiatrist who can guide you toward beginning proper treatment, in addition to learning about prevention methods.
Gout is a foot condition that requires certain treatment and care. If you are seeking treatment, contact Dr. Carl Ginsberg from Pennsylvania. Our doctor will treat your foot and ankle needs.
What Is Gout?
Gout is a type of arthritis caused by a buildup of uric acid in the bloodstream. It often develops in the foot, especially the big toe area, although it can manifest in other parts of the body as well. Gout can make walking and standing very painful and is especially common in diabetics and the obese.
People typically get gout because of a poor diet. Genetic predisposition is also a factor. The children of parents who have had gout frequently have a chance of developing it themselves.
Gout can easily be identified by redness and inflammation of the big toe and the surrounding areas of the foot. Other symptoms include extreme fatigue, joint pain, and running high fevers. Sometimes corticosteroid drugs can be prescribed to treat gout, but the best way to combat this disease is to get more exercise and eat a better diet.
If you have any questions please feel free to contact our office located in Jenkintown, PA . We offer the newest diagnostic and treatment technologies for all your foot and ankle needs.
Read more about Gout