Gout In Ankle: Symptoms And Home Remedies
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Arthritis is basically a joint disorder that causes inflammation in one or more joints of the body. As such there are more than 100 types of arthritis.
But the most common ones can be classified as osteoarthritis, rheumatoid arthritis, ankylosing spondylosis, gout, etc.
What Is Gout?
In medical terms, gout is a complex form of inflammatory arthritis condition which is caused due to the build-up of uric acid.
Although it can affect varied body parts, it is most common in the joints of the foot and big toe.
The first and foremost diagnostic tool helpful for ruling out gout in the foot or ankle is by proper physical examination.
With mere examination, most experienced physicians can confirm the existence of gout in the ankle joint.
In case of a doubtful diagnosis, you can go for a complete blood test added with levels of blood uric acid check-up. Most of the time blood test will give you a clear diagnosis of the condition.
In case if the blood reports also fail to rule out gout in the foot then your doctor can use other diagnostic tools like imaging techniques.
The major imaging techniques which help in confirming the ankle gout are X-rays, CT-Scan, MRIs, etc.
Even sometimes the tests like bone density test and bone biopsy also help in confirming gout in the ankle and foot.
Ankle Gout How To Tell If You Have It
Gout on the Ankle
Although no joint is exempt from gout, the condition usually begins first on one toe joint. An attack can be so severe that pain and inflammation may affect the ankle too. Most of the time though only one joint is affected at one time. In rare cases, only the ankle joint may suffer severely.
Pure ankle gout is considered atypical or not as common as gout affecting only the toe. When ankle gout does happen though, it can be easily misdiagnosed. You or a health care provider might think that it is a sprain or a case of cellulitis.
Misdiagnosis of ankle gout is especially possible among low risk people. Those who are in the high-risk group are usually men over 40. Women who are past menopause may also develop gout. Younger people therefore who may have gout may not easily be imagined to have the condition.
Doctors usually find out if a patient has ankle gout by looking at the symptoms and lab test results. A doctor may have to gather fluid from the joint and send it to a lab for analysis. The fluid may offer evidences of the presence of urate crystals which causes gout.
Other Things to Look Out For
Sometimes though, if ankle gout is left untreated, one may develop tophi. This is when the urate crystals form a hardened mass that is evident through the skin.
Taking Care of Your Gout
How Can A Gout Attack Be Prevented
Diet plays a key role diet in gout prevention: Since foods can directly set off gout attacks, patients with gout should receive counseling as to which foods are more likely to induce attacks. Losing weight is often also helpful. However, as important as diet is in gout, for most people with gout diet, and even weight loss, are not enough, and medications will be needed to get to their uric acid goal.
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The Role Of Diet In Gout Prevention
Dietary control may be sufficient in a patient with mildly elevated uric acid, for example, 7.0 mg/dL
For those with a higher level, for example, 10.0 mg/dL, diet alone will not usually prevent gout. For the latter, even a very strict diet only reduces the blood uric acid by about 1 mg/dL- not enough, in general, to keep uric acid from precipitating in the joints. The cutoff where patients with gout seem to dramatically reduce their number of attacks is when their uric acid level is taken below 6.0 mg/dL.4
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.
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Symptoms And Signs Of Gout In Foot
An attack of gout is often sudden. Symptoms:
- It may present with excruciatingly painful swelling of joints in the big toe, it is known as Podagra. The joint may be stiff and appear red or purple, very swollen, and tender to even light touch. Other gout sites include the instep, wrist, ankle, fingers, and knee.
- Skin may peel and itch as healing begins.
- An attack often begins at night the acute phase lasts up to 12 hours. If untreated, the inflammation may last up to two weeks. In 10 percent of people, acute episodes present in more than one joint.
- Kidney stones precede the onset of gout in 14 percent of patients.
- Chronic gout may develop, and it may affect more than one joint, mimicking rheumatoid arthritis.
- Tophi are soft tissue swellings caused by urate buildup in chronic gout. They may be found in the ear, fingers, toes, kneecap, and elbow.
Some people have a single attack of gout, others are affected intermittently, often when they have overindulged or experienced dehydration.
COMPLICATIONS OF GOUT IN FOOT
Its rare for complications of gout to develop, but they do happen and can include severe degenerative arthritis, secondary infections, kidney stones and kidney damage, nerve or spinal cord impingement, and joint fractures.
Medications For Acute Gout
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How Is Gout Treated
To treat a gout attack or reduce your chances of another, try this mix of medicine and lifestyle changes:
- Elevate the joint and apply ice.
- Drink fluids, but avoid sugary drinks and alcohol.
- Change your diet: Restrict your use of high purine foods, high fructose drinks, and alcohol.
- Medicines: Certain medicines can be used during an attack to relieve symptoms. Others can be used after an attack to lower uric acid levels.
- Nonsteroidal anti-inflammatory drugs : Ibuprofen and naproxen can relieve pain during an attack. Aspirin should not be taken because it can raise uric acid levels.
- Corticosteroids: These can be taken by mouth or injected into your joints during a gout attack.
- Colchicine: While this drug can relieve gout pain and inflammation, it has significant side effects.
- Drugs to lower uric acid levels: Following an attack of gout, your doctor may prescribe a drug to help your body lower or eliminate excess uric acid.
What Are The Symptoms Of Gout
An episode of gout is called a gout attack. Gout attacks are very painful and can happen quite suddenly, often overnight. During a gout attack, symptoms in the affected joint may include:
- Intense pain.
- Tenderness, even to light touch, such as from a bedsheet.
- Warmth, or a feeling like the joint is on fire.
- How long does a gout attack last?
A gout attack can last a week or two. Between gout attacks, you may have no symptoms at all.
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Which Joints Are Involved In Gouty Arthritis And Why Is It Most Common In The Foot
As with all other known types of arthritis, Gout has particular joints it tends to attack, and the foot is its most common location. Gout especially favors the bunion joint, known as the first metatarsophalangeal joint , but the ankle, midfoot and knee are also common locations, as is the bursa that overlies the elbow.
The bunion joint is the first joint involved in 75% of patients and is ultimately involved in over 90% of those with this condition. . It is thought that this joint is especially involved in gout because it is the joint that receives the highest pounds per square inch of pressure when walking or running.
Late in gout, if untreated, multiple joints can be involved, including the fingers and wrists. The shoulder joint is very rarely involved by gout and the same is true of the hip.
Figure 5: Location of Gout Attacks
What Are The Causes Of Gout
A buildup of uric acid in the body is the main cause of gout. A byproduct of the breakdown of purinesorganic chemical compounds present in food and various tissues and cells throughout the bodyuric acid is typically excreted from the body in the form of urine. A buildup, however, occurs when the body is unable to dispose of all the uric acid. This condition is known as hyperuricemia and results in the formation of uric acid crystalsmonosodium uratein the affected joints.
For some patients, this can lead to the symptoms of gout, i.e., inflammation, pain, swelling, and loss of movement in the joints. These symptoms are often severe in intensity. However, for some patients, hyperuricemia may not lead to the onset of gout, and treatment, in this case, is not necessary.
Adults over the age of 40, in particular men, are more likely to experience gout symptoms. Studies show that the disease also affects patients with the following conditions or lifestyles:
- high blood pressure, especially those that use diuretics
- organ transplants
- a diet high in foods containing purines, fructose, and alcohol
The chances of you experiencing gout also increase greatly if other members of your family have previously had the disease.
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Treatment Options For Gout
Gout is a painful metabolic disorder caused by a build-up of uric acid in the joints. Although any joint can be affected, the big toe is the most common location for an episode of gout. If you experience the painful symptoms of gout near Houston , visit a foot doctor for treatment.
For gout, your foot and ankle specialist may provide medications to reduce swelling and inflammation and manage pain. Drinking plenty of water each day will help flush the uric acid out of your body. Your foot doctor may also suggest dietary restrictions, particularly avoiding foods that are high in purines that are converted to uric acid by the body. Elevating your foot will also help with swelling.
If you have repeated episodes of gout, you may develop gouty arthritis, which causes erosion of the surface of the impacted joint. If this occurs, you may need surgery to repair the joint and clear out uric acid crystals.
Treating Gout With Medications
Certain medications reduce the pain and inflammation of gout attacks, such as anti-inflammatory drugs , colchicine, and corticosteroids. Other medications decrease the level of uric acid in the blood and prevent the deposit of uric acid in joints , the kidneys , and in tissue , helping to prevent further attacks and complications. These drugs include allopurinol, febuxostat, lesinurad, and probenicid.
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Causes Of Gout In Ankle
As said before, gouty arthritis is a condition that occurs in the human body due to the accumulation of a substance called uric acid in the bloodstream.
This abnormal accumulation of uric acid in the bloodstream happens due to excess workload on the liver and kidneys.
When this happens it leads to the deposition of uric acid crystals all over the body mainly over the joints.
Initially the uric acid deposits as a solution. But on long-standing, the uric acid solution becomes uric acid crystals.
Slowly it starts pressuring the nearby parts of the joints like tendons, cartilage, muscles, nerves, and blood vessels.
This ultimately leads to damage of the joint tissues and thus creates unwanted and unbearable pain along with swelling.
Gout may happen in all the joints of the body but primarily it affects the base of the big toe and the ankle joints.
The ankle joint is the principal joint for balancing the whole body.
And as gout occurs initially in the ankle joints it creates much trouble for the person in performing the day-to-day daily tasks.
The Role Of Medication In Prevention Of Gout
Table 3: Medications to pevent attacks of gout
Standard medications in preventing gout attacks
i. Colchicine : using the matches analogy discussed above1, using colchicine can be seen as dampening the uric acid matches. Colchicine does not lower the bodys store of uric acid, but it decreases the intensity of the bodys inflammatory reaction to these crystals. Recent studies have shown that at least one mechanism of colchicines action is by acting to prevent a cascade of reactions that lead to the production of interleukin 1-beta, which is an inflammatory protein , which is important in gouty inflammation.8
ii. Allopurinol: This agent is presently the most commonly used drug for the prevention of gout. Allopurinol blocks the enzyme xanthine oxidase, which blocks the breakdown of purines, thus decreasing the bodys total amount of uric acid. Allopurinol is effective in preventing gout no matter what the mechanism of the elevated uric acid was. Whether a person is making too much uric acid, or has difficulty excreting it via the kidney, allopurinols decrease in uric acid production leads to the same goal: a decreased total body uric acid.
Table 4: Reasons to use medication to lower uric acid
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Why Work With Dr Verville For Your Gout
Frisco patients suffering from gout can get some of the finest treatment with Dr. Verville. Shes been a practicing podiatrist for over 10 years and has performed over 1,500 surgical procedures. On top of that, patients love how gentle and compassionate she is with all of her patients. Dr. Verville works hard to develop strong and transparent relationships with all of her patients so that they feel comfortable and welcomed by her. We know that gout can be excruciatingly painful so make sure that you call Dr. Verville today for a consultation at . We would love to learn more about you and how we can help.
How Long Does Gout In The Ankle Last
Gout flare-ups can last for several hours at a time, but you may feel pain in your ankle for days or weeks. Some people only have one flare-up in their life, while others have them several times a year.
Keep in mind that gout is a chronic condition, meaning it lasts for a long time and requires ongoing management. Dietary changes and medications can make a big difference, but youll also be at risk of having a flare-up.
Keep in mind that it can also take some time to find the right combination of diet changes and medication that works for you. Dont be discouraged if things dont seem to be improving right away.
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What Triggers Gout Flare
Ankle gout can be extremely painful and can lead to complex conditions if not cared for at initial levels.
Knowing about certain factors that trigger gout pain can be most helpful not only in avoiding the problem but also in curing and managing it effectively.
Following are the most common risk factors which can trigger the problem:
Surprising but true, your diet and food items are one of the major causes of triggering gout pain in your foot and ankle.
Studies reveal that food items such as red meat, organ meat, seafood, and many types of fishes are the foods to avoid with gout as these are purine-rich and cause problems.
Alcohol and beverages that are rich in sugar also increases the levels of uric acid in your body and therefore put you at higher risk of getting intense gout pain.
Medical conditions and Medications:
Health conditions such as high blood pressure, diabetes, heart, and kidney diseases if left untreated for long can affect your health adversely by causing many future problems like foot gout.
It is therefore good to take necessary preventive measures and regular health check-ups after a certain age so that you can avoid all these conditions easily.
Experts also suggest that you should limit yourself from taking certain medications like diuretics and aspirin which can put you at risk of getting higher gout pain in the ankle as it increases the level of uric acid.
Family History, Age, and Gender:
Besides the above, few other gout risk factors include: