My big toe pain is a huge problem

I HAD my big toe joint surgically fused three years ago to combat arthritis. But my foot is now causing me pain at night. My GP has suggested a drug called gabapentin, but I’m a fit and active 73-year-old woman and reluctant to take it. Is there anything else I can try? ARTHRITIS involves the gradual destruction of cartilage inside the joints. Cartilage is like a cushion that nestles between the ends of the bones where they meet and stops them from rubbing together. When it breaks down, the bones come into contact, triggering pain and inflammation.

One of the most effective ways to treat arthritis of the big toe is to fuse the two adjoining bones, screwing them together so they knit and become one. It does mean the toe becomes stiff and doesn’t bend like it used to but most people are able to walk fine with it and, crucially, it can soothe pain and tenderness.

After surgery, some people do suffer long-term pain, often in the other toes as the balance of weight shifts to different areas of the foot.

Burning pain years later could be related to the operation, or damage to the nerve, known as neuropathy.

Normal painkillers do not work for this type of pain.

That’s why doctors use gabapentin, a specific type of medication for nerve pain.

However, gabapentin has wellknown side effects (including speech problems, constipation and nausea) and can be difficult to come off.

So it is a big undertaking which must be weighed up carefully against how bad the pain is. It may be more appropriate to start on an alternative nerve painkiller, such as amitriptyline, which has fewer side effects, or even a cream called capsaicin.

This is derived from chillies and medically recommended for nerve pain.

Although it can irritate the skin, the beauty of a cream is the lack of whole-body side effects. YOU recently wrote about how an exclusion diet can ease symptoms of irritable bowel syndrome. What does it involve? UP to one in five people in Britain suffers with IBS. Stomach cramps, bloating, diarrhoea, constipation and fatigue can make their lives pretty miserable.

Experts now recognise that IBS has clear dietary triggers, so it makes sense for patients to try changing what they eat to relieve symptoms.

In the absence of any truly effective drugs for the condition, focusing on diet may be your best option.

But it is important to be aware that different diets target different IBS symptoms, so it is essential to pick the right one.

For bloating and diarrhoea, for example, there is a regime called the low FODMAP diet – it eliminates foods that contain carbohydrates and sugars that aren’t easily digested. It is also worth avoiding caffeine, wholegrain foods and alcohol if diarrhoea is a major symptom.

For someone with constipation, improving your soluble fibre intake with linseed, oats or ispaghula – a type of supplement which acts as a laxative – is a better solution. But increase these foods gradually to avoid bloating and gas. Drinking enough fluid and taking a daily probiotic is also worth trying.