Gout is a type of arthritic disorder that occurs when uric acid accumulates in the blood and eventually finds its way to the joint, where it crystallizes and causes joint inflammation.  There are two mechanisms by which uric acid builds up. The first and most common reason is that your body is simply producing too much uric acid. The second mechanism, and less common, is that your body is unable to properly remove the uric acid. In both cases, excess levels of uric acid build up in the fluid around joints resulting in the formation of uric acid crystals.  These crystals cause the affected joint to become inflamed and painful. In the foot, the big toe is the most common joint affected.

What Causes Gout Attacks:

There are many factors which may predispose an individual to developing a gouty attack. High blood pressure, high cholesterol, and diabetes are a few examples of medical conditions that are shown to be associated with gout. It has also been shown that overweight individuals are more at risk for developing gout as well as those people who lead a more sedentary lifestyle. A person’s diet can also put them at risk for developing gout. Sugar-sweetened soft drinks, fructose-rich fruits and fruit juices, beer, meat and seafood are examples of food and drinks are major risk factors if they are consumed in excess.

As mentioned before, gout typically affects the big toe. Why? Because the protein will settle in cold joints and since the big toe joint is the furthest from the heart, it is the coldest.  That is why gout attacks can occur in the middle of the night.

However, it can also affect other joints, like the knee and ankle joints.  The painful symptoms typically occur suddenly. The joint affected may be warm, swollen, red, and very sore. A common complaint is that even laying in bed with a sheet over the affected area can cause extreme pain. If this is your first gout attack the pain may go away in a few days, but it is possible for additional attacks to occur, each one lasting longer than the previous attack.  It is best to get an early start on treatment. If gout is left untreated the risk of causing progressive joint and tissue damage is greatly increased.

Diagnosing Gout:

There are a few tests your doctor may order to confirm a diagnosis of gout.  They may order urine and blood tests to see if uric acid can be detected. They may also perform an analysis of the fluid in the joint, called synovial fluid, to confirm gout microscopically. If gout is confirmed, your doctor will prescribe a medication that should be started right away. After starting treatment, the pain should begin to resolve within 12 hours and you should be completely relieved of pain in 48 hours. Your doctor may also prescribe another medication that should be taken daily. This medicine will prevent developing chronic gout and will decrease uric acid levels in your blood. 

Preventing Painful Gout Attacks:

Gout can be prevented by making a few easy lifestyle and diet changes. Limit your intake on the foods and drinks that are associated with developing gout.  Limit the amounts of meat, fatty foods, and fructose rich fruit juices you are consuming. Try to lose weight and be more active during the day. Gout is a painful arthritic disorder, but with proper treatment and management of you can live a normal pain-free life.


Peter Wishnie, D.P.M.
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Owner of Family Foot & Ankle Specialists in Piscataway and Hillsborough, NJ. Make an appointment today!