What Is Gout Know The Signs And Risk Factors
4 Minute Read
Medically Reviewed by UPMC Orthopaedic Care
Gout is a potentially debilitating form of inflammatory arthritis that causes pain, redness, stiffness, and swelling in your joints. More than 8 million people in the United States have gout.
The condition usually affects one joint at a time. About half of all gout attacks begin in the big toe, but it also can occur in the ankles, heels, knees, wrists, fingers, and elbows.
Although gout can cause pain, it can be managed with proper treatment.
Treatment Step #: Prevent The Top Of The Foot Gout Pain From Coming Back
- Gout can happen for many reasons in many different people.
- Basically, the healthier you are, the better you eat, the less gout you will have.
- If you are hydrating well, if your kidneys are working well, and if you can get into reasonable health, gout attacks should be fairly limited.
- If you do have a genetic reason or possibly a kidney issue, many medications are available to help with your gout pain.
- The most common medication in preventing frequent attacks is allopurinol. Fortunately, most people with gout attacks never get to this point where they need lifelong medication for their gout.
How Is Gout Treated
Gout can be effectively treated and managed with medical treatment and self-management strategies. Your health care provider may recommend a medical treatment plan to
- Manage the pain of a flare. Treatment for flares consists of nonsteroidal anti-inflammatory drugs like ibuprofen, steroids, and the anti-inflammatory drug colchicine.
- Prevent future flares. Making changes to your diet and lifestyle, such as losing weight, limiting alcohol, eating less purine-rich food , may help prevent future attacks. Changing or stopping medications associated with hyperuricemia may also help.
- Prevent tophi and kidney stones from forming as a result of chronic high levels of uric acid. Tophi are hard, uric acid deposits under the skin. For people with frequent acute flares or chronic gout, doctors may recommend preventive therapy to lower uric acid levels in the blood using drugs like allopurinol, febuxostat, and pegloticase.
In addition to medical treatment, you can manage your gout with self-management strategies. Self-management is what you do day to day to manage your condition and stay healthy, like making healthy lifestyle choices. The self-management strategies described below are proven to reduce pain and disability, so you can pursue the activities important to you.
Read Also: Is Rice Good For Gout Patient
How Can High Uric Acid Cause Heel Pain
So, why does gout show up in the feet ? Uric acid is very sensitive to cooler temperatures. As it circulates throughout the body and reaches the feet , the liquid uric acid crystalizes, leading to pain in the joints of the big toe or joint of the heel .
Uric acid levels rise when your body breaks down purines. Purines are found in foods like red meat and alcohol, as well as in certain medications and naturally in the human body .
Most of the time, your body is able to manage uric acid levels effectively, simply dumping the uric acid into your kidneys where it is excreted as urine. However, when uric acid levels get high enough, your kidneys may struggle to keep up, and uric acid may stay in your bloodstream where it causes inflammation, pain, and swelling as it crystallizes in the joints of the foot.
Treatment Step #: Weigh The Pros And Cons Of Treating Foot Gout Long Term:
- Most people never need to take lifelong gout medication. There are many pros and cons to taking medication.
- Most gout attacks are not actually gout. We feel that gout is overrepresented, especially when it is really arthritis pain.
- If you do have frequent attacks every year, and it really is gout, many gout medications can be taken.
Recommended Reading: What Does Gout Feel Like In Your Elbow
What Does The Future Hold For Gout
Active research is ongoing in a variety of fields related to gout and hyperuricemia. Scientists have found that high animal protein slightly increased the risk for gout. New drugs are being developed that may be more versatile and safe in treating the elevated uric acid levels in patients with chronic gout.
Medications For Gout Attacks
To treat gout attacks and to prevent future ones, you doctor may recommend these medications:
Nonsteroidal anti-inflammatory drugs
Initially, your doctor might suggest over-the-counter NSAIDs, such as naproxen sodium or ibuprofen .
If these OTC medications arent enough, your doctor might prescribe more powerful NSAIDs such as celecoxib or indomethacin .
Colchicine
Colchicine is a medication that your doctor may prescribe based on its proven effectiveness in reducing heel gout pain.
Side effects of taking colchicine, especially in large doses, can include diarrhea, nausea, and vomiting.
Corticosteroids
If NSAIDs or colchicine arent appropriate for you, your doctor might recommend corticosteroid medications, either in pill form or via injection, to control inflammation and pain.
An example of this type of medication is prednisone.
Recommended Reading: Home Remedies For Gout In Feet
What Does A Gout Attack Look And Feel Like What Would A Foot Or Toe With Gout Look Like
When gout occurs, the joint tends to be extremely painful and is warm, red and swollen . The inflammation that is part of a gout attack is systemic, so that fever and chills, fatigue and malaise are not uncommonly part of the picture of a gout attack.
Figure 6: Toe with Acute Attack of Gout
Gout attacks can occur in joints that look normal, or in joints that have easily visible deposits of uric acid. These deposits are called tophi and can be in numerous locations, but especially on the feet and elbows. In Figure 9, the little finger of the right hand is bandaged since fluid was just removed from it, which demonstrated innumerable uric acid crystals.
Figure 7a: Tophi on Foot
Figure 7b: Tophus Over Achilles’ Tendon
Figure 8: Tophus on Elbow
Figure 9: Tophi on Hands
Figure 10: Large Tophus of Finger
While some gout attacks will solve quickly by themselves, the majority will go on for a week, several weeks, or even longer if not treated. Since gout attacks are usually quite painful and often make walking difficult, most gout sufferers will request specific treatment for their painful condition.
What Are The Causes And Triggers Of Gout In The Ankle
The buildup of uric acid in the body is known as hyperuricemia. Your body produces uric acid when it breaks down purines. These are compounds found in all your cells. You can also find purines in several types of food, especially red meat and some seafood, as well as alcohol and some sugar-sweetened drinks.
Usually, uric acid passes through your kidneys, which help to eliminate extra uric acid in your urine. But sometimes theres too much uric acid for your kidneys to handle. In other cases, the kidneys cant process a typical amount of uric acid due to an underlying condition.
As a result, more uric acid circulates throughout your body, ending up in your ankle as uric acid crystals.
4 percent of adults in the United States. It tends to be more common in men because women usually have lower levels of uric acid. But after menopause, women start to have higher uric acid levels. As a result, women tend to develop gout at an older age than men do.
Experts arent sure why some people produce more uric acid or have trouble processing it. But theres evidence that the condition is often genetic.
Other things that may increase your risk of developing gout include:
- consuming a lot of high-purine foods
- consuming foods and drinks, especially alcohol, that increase uric acid production
- being overweight
Read Also: What To Do For Gout In Elbow
Gout In Foot: Causes And Risk Factors
In about 90 percent of hyperuricaemia cases, there is impaired renal excretion in about 10 percent, there is a problem with overproduction.
- Urate overproduction can be linked to lifestyle factors and certain diseases such as bone marrow cancers, psoriasis, and hemolytic anemia. Lifestyle factors include being overweight and ingesting excess amount of fructose or alcohol.
- Renal impairment has multiple causes, including gene mutations, hypertension, diuretic drugs, lead exposure, and cyclosporine immunosuppressive therapy.
- Gender and age. Men are twice as likely to develop gout as women. In men, the risk rises with age. Gout is uncommon in younger women but the incidence increases dramatically after menopause, due to falling estrogen.
- Western diet. There is solid evidence from the Health Professional Follow-up Study of a link between gout and purine-rich foods. See gout diet.
- Medications. Diuretics, antihypertensives, niacin, aspirin, chemotherapy and immunosuppressive drugs increase the risk of gout.
- Other conditions. Certain conditions carry an increased risk of gout including: Recent joint injury or surgery, cardiovascular disease, chronic pulmonary disease, anemia, psoriasis, renal disease, blood cancers, and metabolic syndrome.
Build Muscle With Strength Exercises
Having strong muscles can protect your joint from wear and tear, especially for joints affected by gout. Beyond weight training, simple resistance exercises can be effective to build muscle. For example, try an elastic resistance band by holding each end and putting your foot in the middle, then repeat your flexibility exercises while pushing against the force of the band.
The key with any exercise after a gout flare is to go slow and listen to your body, Dr. Iversen stresses.
Don’t Miss: How Does Uric Acid Cause Gout
Whats The Outlook For People With Gout
Untreated gout can lead to permanent joint damage. The buildup of uric acid in the joints and soft tissue is called tophus. Some people with gout can also develop other health problems, such as severe arthritis, kidney stones and heart disease. Its important to discuss your symptoms with a healthcare provider.
Treating And Preventing Gout Pain
Gout pain is generally treated in two ways:
- Medications to relieve gout attacks in the short-term
- Preventive medications taken regularly to lower uric acid and stop gout attacks from occurring
While inflammation-fighting drugs are used to relieve pain during gout flares, different medicines are used to lower uric acid levels to prevent future attacks. These include:
- Allopurinol
- Probenecid
Another medication called pegloticase may be recommended for people with chronic gout who have not responded to other uric acid-lowering medication.
While many people with gout can be treated by their primary care physician, if gout is not responding to medication or is progressing with worsening or frequent flares or developing tophi gout deposits, then your primary care physician may refer you to see a rheumatologist who specializes in treating diseases that affect joints, muscles, bones and the immune system.
Taking medication to reduce uric acid levels and reduce the risk of gout progression is important, Dr. FitzGerald stresses. If you have risk factors for bad gout, such as kidney disease, or are experiencing frequent attacks, early treatment is better.
You May Like: Home Remedy For Gout Relief
It’s Easy To Get The Care You Need
See a Premier Physician Network provider near you.
If you havegout, youre all too familiar with the sudden, burning joint pain that a gout attack can bring on most commonly in the big toe.
Gout a type ofarthritis is caused by too much uric acid in the blood. Usually, having an excess of uric acid isnt harmful. In fact, many people with high levels in their blood never get gout. But when uricacid levels in your blood are too high, the uric acid may form hard crystals in your joints.
Can Gout Affect The Top Of Your Foot
Almost all of the gout in the foot is on top of the big toe joint. In this way, it can radiate across the nerves up your foot, making it seem like it is affecting the top of the foot.
Yes, gout can affect the top of your foot. The most common areas of gout attacks are:
- Gout most commonly attacks the big toe joint.
- Over 50% of all gout attacks are in the big toe joint. In our opinion, it is even higher than this, especially the symptomatic gout attacks.
- This can usually happen on the top part of the front of the foot.
- The pain is so severe that it seems to radiate up the top of the foot, almost into the ankle.
- Gout can also occur in the small toes as a secondary site.
- Gout usually does not occur in the top and middle part of the foot unless you have prior arthritis. But it is common to have the pain radiate up to this site if the big toe is really throbbing.
- The skin is thinner on top of the foot, so some people feel the gout attack more here.
- You can also get gout under the foot, but this happens at the bottom of your big toe.
- The main way to know that it is gout is that it usually shows up quickly without a prior attack.
Consider a pinched nerve as an alternative to gout on the top of your foot.
Gout on top of your foot is usually not gout at all, based on what we see regularly.
Also Check: What To Do For Gout In Your Ankle
What To Do For A Gout Attack
Medication may shorten a gout attack. Your doctor may prescribe medication that blocks inflammation called a nonsteroidal anti-inflammatory drug , you may also take a drug called colchicine or a strong anti-inflammatory steroid drug. Over-the-counter NSAIDs include ibuprofen and naproxen.
These drugs will reduce the pain and inflammation, but there are also home treatments that will help. Home treatment includes resting your joint, elevating your joint above the level of your heart, and using ice packs to reduce pain and swelling.
Risk Factors And Potential Causes Of Gout
Gout strikes men more often than women until women undergo menopause, and then women experience increased risk. Being overweight or obese, having recent surgery, and experiencing a trauma also increase your risk, as well as your family history.
Your body produces uric acid when it breaks down purines a substance found naturally in your body, and also in high-protein red meat, organ meat, and certain types of seafood. In addition, alcoholic drinks, beer, and beverages sweetened with fructose can raise your natural uric acid levels. When your body either creates too much uric acid or excretes too little, it can lead to gout. Hundreds of years ago, gout was called the disease of kings because the average peasant couldnt afford such rich food and drink.
Medical conditions like untreated high blood pressure, diabetes, heart disease, and kidney disease can also increase your chances of developing gout, as does taking certain medications, such as thiazide diuretics and low-dose aspirin.
Don’t Miss: How Do They Test For Gout
What Causes Gout Pain
Picture a collection of glass shards pressing outward like needles. This is what it can feel like during a gout flare, when a buildup of uric acid in the blood forms microscopic crystals that grow in and around a joint. As the build-up increases, the immune system responds to these crystals, causing inflammation that leads to visible swelling, redness, and debilitating pain.
In some cases, a gout flare can even lead to a fever and look like an infected joint, Dr. FitzGerald notes. The treating doctor may need to look for possible source of infection, often by removing fluid from the joint to send to the lab to look for crystals or bacteria.
Uric acid is a byproduct of the body breaking down proteins called purines from your own cells and from certain foods such as red meat and shellfish. Alcohol and drinks sweetened with high fructose corn syrup are also high in purines. Normally, uric acid dissolves in your blood and is filtered out through your kidneys, but when your body produces too much uric acid or your kidneys fail to filter it, either due to familial causes or kidney disease, then the uric acid builds up and creates the needle-like urate crystals that cause gout and can also form kidney stones, according to the Mayo Clinic.
Certain factors make some people more likely to develop gout, according to the U.S. Centers for Disease Control and Prevention. Gout risk factors include:
Exercising Helps Control Gout By Lowering Uric Acid Levels To Prevent Gout Attacks
Researchers have found that fat in the body carries more uric acid than muscle. Thus, when you reduce body fat, you can reduce uric acid levels in your blood, Dr. Iversen notes. Building cardiovascular health through exercise is also very important for people with gout because they have a higher risk of developing high blood pressure, according to Harvard Health. Gout is also strongly associated with developing coronary artery disease.
You May Like: What Does Prednisone Do For Gout
When Is Surgery Considered For Gout
The question of surgery for gout most commonly comes up when a patient has a large clump of urate crystals , which is causing problems. This may be if the tophus is on the bottom of the foot, and the person has difficulty walking on it, or on the side of the foot making it hard to wear shoes. An especially difficult problem is when the urate crystals inside the tophus break out to the skin surface. This then can allow bacteria a point of entry, which can lead to infection, which could even track back to the bone. Whenever possible, however, we try to avoid surgery to remove tophi. The problem is that the crystals are often extensive, and track back to the bone, so there is not a good healing surface once the tophus is removed. In some rare cases, such as when a tophus is infected or when its location is causing major disability, surgical removal may be considered.
Since it is hard to heal the skin after a tophus is removed, a skin graft may be needed. For this reason, we often try hard to manage the tophus medically. If we give high doses of medication to lower the urate level, such as allopurinol, over time the tophus will gradually reabsorb. In severe cases, we may consider using the intravenous medication pegloticase , since it lowers the urate level the most dramatically, and can lead to the fastest shrinkage of the tophus.