Gout
Foot & Ankle Care of Colorado
Gout is a common and complex form of arthritis that can affect individuals of any age. It is characterized by sudden, severe episodes of pain, swelling, redness, and tenderness in one or more joints, most frequently in the big toe.
A gout attack can occur abruptly, often waking patients in the middle of the night with intense pain and a sensation of heat in the affected joint. The joint becomes hot, swollen, and so tender that even the weight of a bedsheet may be unbearable.
While gout symptoms may be intermittent, there are effective strategies to manage symptoms and prevent future flares.
Causes of Gout
Gout attacks are caused by the deposition of crystallized uric acid in the joints. Uric acid, a byproduct of purine breakdown, is normally present in the blood and excreted in the urine. However, in individuals with gout, uric acid accumulates and crystallizes in the joints. This can occur due to the kidneys’ difficulty in eliminating normal amounts of uric acid or excessive production of uric acid.
Gout most commonly affects the big toe because uric acid is sensitive to temperature changes and crystallizes at cooler temperatures. Since the toe is the furthest point from the heart, it is typically the coolest part of the body, making it a prime target for gout. However, gout can affect any joint.
The propensity to accumulate uric acid is often inherited. Additional risk factors for developing gout include high blood pressure, diabetes, obesity, surgery, chemotherapy, stress, and certain medications and vitamins. For example, aspirin, some diuretics, and niacin (nicotinic acid) can impair the body’s ability to remove uric acid. While gout is more prevalent in men aged 40 to 60, it can also occur in younger men and women.
Consuming foods and beverages high in purines can trigger gout attacks. Foods rich in purines, such as shellfish, organ meats (kidney, liver, etc.), red wine, beer, and red meat, can increase uric acid levels, leading to gout. Limiting or avoiding these foods may help reduce the risk of gout attacks.
Gout Symptoms
An attack of gout can be miserable, marked by the following symptoms:
- Intense pain that comes on suddenly,
often in the middle of the night or upon arising - Signs of inflammation, such as redness, swelling and warmth over the joint
Gout Diagnosis
To diagnose gout, the foot and ankle surgeon will ask questions about your personal and family medical history, followed by an examination of the affected joint. Laboratory tests and x-rays are sometimes ordered to determine if the inflammation is caused by something other than gout.
Nonsurgical Treatments
- Medications. Prescription medications or injections are used to treat the pain, swelling and inflammation.
- Dietary restrictions. Foods and beverages that are high in purines should be avoided since purines are converted in the body to uric acid.
- Fluids. Drink plenty of water and other fluids each day, while also avoiding alcoholic beverages, which cause dehydration.
- Immobilize and elevate the foot. Avoid standing and walking to give your foot a rest. Also, elevate your foot (level with or slightly above the heart) to help reduce swelling.
The symptoms of gout and the inflammatory process usually resolve in three to ten days with treatment. If gout symptoms continue despite the initial treatment, or if repeated attacks occur, see your primary care physician for maintenance treatment that may involve daily medication. In cases of repeated episodes, the underlying problem must be addressed, as the buildup of uric acid over time can cause arthritic damage to the joint.
