Gout: A Not So Royal Pain In The Big Toe

1 May 2018
 Categories: , Blog


Are you suffering from severe pain in your big toe joint? If so, you may be one of the millions of Americans stricken with gout. This form of arthritis sets in as uric acid deposits crystalize within the joints. Find out more about this disease and what you can do to reduce gout's painful flares and complications.

Causes and Risk Factors of Gout

Gout is characterized by hyperuricemia, which is a condition in which there is an abnormally high level of uric acid in the blood. The excess uric acid eventually forms crystals in the joints. The hard and uneven edges of those crystals rub on the joint's structures, leading to the inflammation and pain that present as gout attacks, or gout flares.  

There are a number of risk factors that can contribute to the development of gout, including the following:

  • Obesity
  • A family history of gout
  • Lead exposure 
  • A diet that is high in purines
  • Excessive alcohol consumption 
  • Certain medications, including aspirin, diuretics, immunosuppressant drugs, and chemotherapy drugs 
  • Certain medical conditions, such as hypertension, high cholesterol, hypothyroidism, diabetes, hemolytic anemia, psoriasis, congestive heart failure, kidney disease, and metabolic syndrome
  • Infections and certain physical traumas, such as injury to a joint or surgery

Gout is diagnosed most often in men who are between 30 and 50 years of age. Gout typically does not present in women until the postmenopausal years. Children and young adults are rarely affected by gout.

Signs and Symptoms of Gout

The initial symptom of gout is an extreme pain in one joint. Half of all gout cases affect the big toe joint, but other joints in the body, including the other toes, fingers, wrists, elbows, knees, and ankles, can also be affected. Gout flares usually strike only one joint at a time, and the pain often presents at night. The pain may worsen and continue for several hours and can last for days to weeks. Additional signs and symptoms of gout include the following:

  • The affected joint is swollen and extremely tender.
  • The range of motion and flexibility of the affected joint is limited.
  • The skin at the site of the affected joint is red and warm.

Be sure to bring these symptoms to your physician's attention. If you have gout, failure to pursue a diagnosis and treatment can ultimately lead to permanent joint damage, kidney stones, kidney damage, and tophi, which is the formation of uric acid crystals under the skin.

Diagnosing Gout

To confirm a diagnosis of gout, diagnostic testing must be performed while you are in the throes of a flare. Your physician will conduct a physical examination, ask you questions about your lifestyle and review your medical history. He or she will also order diagnostic tests to determine if your pain is being caused by gout. A blood panel will reveal if the uric acid level in your blood is too high. 

However, not everyone with high blood uric acid levels goes on to develop gout. If your uric acid level is elevated, your doctor may order an arthrocentesis, which is a test in which fluid is taken from your affected joint for laboratory analysis to confirm the diagnosis. A urinalysis will reveal the uric acid level in your urine and evaluate your kidney function, and radiographs of the affected joint will serve to rule out other possible causes of pain and inflammation. Once a diagnosis of gout is confirmed, you and your physician can discuss some treatment options.

How Is Gout Treated?

The first goal of gout treatment is to relieve the pain and inflammation of your current flare. This may be accomplished with the use of nonsteroidal anti-inflammatory drugs, such as ibuprofen or colchicine, or steroids. The following additional steps may be recommended to help decrease your discomfort during a flare:

  • Apply an ice pack or cold compress to the affected joint.
  • Avoid engaging the affected joint in any physical activity.
  • Keep the affected joint elevated as much as possible. 

Once the flare has passed, the second goal of treatment is long-term management to preserve your joint health, prevent future attacks, and maintain a comfortable quality of life. Your doctor may prescribe a medication that helps to lower the uric acid level in your blood. If you are overweight, he or she will recommend a weight loss program of diet and exercise. Periodic blood and urine panels and follow-up examinations are important to ensure that potential complications are detected early in their onset.

Helpful Dietary Changes

Once dubbed as a disease of kings and a rich man's disease, gout was rumored to be an affliction of the wealthy and the result of overindulging in rich foods. It is now understood that gout can strike individuals from any socioeconomic group, threatening to target anyone whose uric acid level is elevated. Certain foods, however, can contribute to the increase in uric acid. Consider reducing your intake of these foods as part of your gout treatment and prevention diet:

  • Meats that are high in purines, such as red meats and organ meats 
  • Fish and seafood that is high in purines, such as scallops, mussels, anchovies, trout and tuna
  • Foods and beverages that are high in fructose, including soda
  • Alcoholic beverages, especially beer, which is also high in purines

Low-fat and nonfat variations of dairy products, such as milk and yogurt, can be helpful in lowering your risk for a gout flare. Drinking plenty of water instead of those beers and sodas to keep yourself hydrated can also reduce your gout flares. 

Gout is painful, and that pain in your big toe will change your stride, interfere with your exercise regimen and prevent you from doing the physical activities that you enjoy. Once your physician has tailored a treatment plan for your condition, compliance is crucial. Uric acid levels that remain abnormally high can ultimately contribute to other health problems, such as kidney stones and joint deformity. Hyperuricemia and gout can be controlled. Do not delay in seeking a diagnosis and pursuing relief from this painful condition. 

For more information, contact a company like Mid Nebraska Foot Clinic.