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.
How Does A Doctor Diagnose Gout
If you have sudden or severe pain in a joint, you should talk to your primary care provider . Your PCP may send you to a rheumatologist, a doctor who specializes in gout and other kinds of arthritis.
Healthcare providers consider several things when confirming gout:
- Symptoms: The provider will ask you to describe your symptoms, how often they happen and how long they last.
- Physical examination: Your provider will examine the affected joint to look for swelling, redness and warmth.
- Blood work: A test can measure the amount of uric acid in your blood.
- Imaging tests: You may have pictures taken of the affected joint with X-rays, an ultrasound or MRI.
- Aspiration: The provider may use a needle to pull fluid from the joint. Using a microscope, a team member can look for uric acid crystals or a different problem .
Leading A Gout Free Life
In order to avoid gout attacks, your gout physician may prescribe a medication to reduce the buildup of uric acid in your blood. In most cases patients take this medicine for their entire life, but there are things that you can do reduce the chances of needing a lifetime of medication. Pay special attention to what you eat. This can help you manage the buildup and uric acid and reduce the frequency and duration of your gout attacks. Eating appropriate amounts of a healthy variety of foods to keep your weight under control and to get the nutrition you need. Try to avoid frequent or daily meals consisting of meat, seafood, and alcohol. As always you should drink plenty of fluids, especially water.
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How Can I Manage My Gout And Improve My Quality Of Life
Gout affects many aspects of daily living, including work and leisure activities. Fortunately, there are many low-cost self-management strategies that are proven to improve the quality of life of people with gout.
For gout in particular:
- Eat a healthy diet. Avoid foods that may trigger a gout flare, including foods high in purines , and limit alcohol intake .
CDCs Arthritis Program recommends five self-management strategies for managing arthritis and its symptoms. These can help with gout as well.
Treating A Gout Attack
The methods of stopping an attack of gout can vary depending on the severity of pain. Your orthopedic physician may give you a shot of corticosteroids. They may also prescribe other types of medications that are specifically designed to treat gout. To ease the pain during a gout attack, rest the joint that hurts. Non-steroidal anti-inflammatory medicine may also be prescribed to help reduce the pain. The good news is that following treatment, relief from the pain and discomfort of a gout attack often begins within 24 hours. It is important to still make an appointment with your orthopedic physician even if your pain from gout is gone. The buildup of uric acid that led to your gout attack can still harm your joints. An orthopedic physician will help you get relief from the pain of gout attacks and learn ways to prevent flare-ups in the future.
*The blog is for general information and educational purposes only regarding musculoskeletal conditions. The information provided does not constitute the practice of medicine or other healthcare professional services, including the giving of medical advice, and no doctor-patient relationship is formed. Readers with musculoskeletal conditions should seek the advice of their healthcare professionals without delay for any condition they have. The use of the information is at the readers own risk. The content is not intended to replace diagnosis, treatment or medical advice from your treating healthcare professional.
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Top Of The Foot Home Treatment:
- There are usually two phases to treating the top of the foot pain treatment.
- This doesnt matter whether its an intermittent sharp pain on top of the foot, pain on top of the foot near toes, tendonitis on top of the foot, or a top of the foot bone spur. Treatment is all roughly very similar.
- The two phases of treatment include controlling the acute inflammation and correcting the biomechanics, which led to the problem in the first place.
- Great top-of-the-foot shoes and great orthotics lead to the prevention of dorsal compression syndrome. This prevents compression on top of the foot. It prevents the stretching on the bottom of the foot.
- This will also reduce your numbness, burning, and tingling pain.
Can It Lead To Any Complications
If left unmanaged, gout-related inflammation can cause permanent damage to your ankle joint, especially if you have frequent flare-ups.
Over time, lumps of uric acid crystals, called tophi, can also form around your ankle. These lumps arent painful, but they can cause additional swelling and tenderness during a flare-up.
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What Else Should I Ask My Healthcare Provider About Gout
Consider asking your healthcare provider:
- What is causing the gout?
- Do I have any joint damage?
- What can I do to prevent future attacks?
- Can any gout medications help me?
- How long will I need to take gout medications?
A note from Cleveland Clinic
Gout is a painful form of arthritis. Extra uric acid in your body creates sharp crystals in the joints, leading to swelling and extreme tenderness. Gout usually starts in the big toe but can affect other joints. Gout is a treatable condition, and the uric acid level can be decreased by medication and lifestyle changes. Talk to your healthcare provider about medications that can reduce uric acid levels. They can also discuss changes you can make to your diet and lifestyle to prevent and reduce gout attacks.
Last reviewed by a Cleveland Clinic medical professional on 11/15/2020.
References
How Is Gout Diagnosed
In a clear-cut case, a primary care physician can make the diagnosis of gout with a high level of confidence. However, often there are two or more possible causes for an inflamed toe or other joint, which mimics some of the symptoms of gout, so tests to identify the presence of uric acid is performed.
Since the treatment for gout is lifelong, its very important to make a definitive diagnosis. Ideally, the diagnosis is made by identifying uric acid crystals in joint fluid or in a mass of uric acid . These can be seen by putting a drop of fluid on a slide and examining it using a polarizing microscope, which takes advantage of the way uric acid crystals bend light. A non-rheumatologist, when possible, can remove fluid from the joint by aspirating it with a small needle and send it to a lab for analysis. A rheumatologist is likely to have a polarizing attachment on their microscope at their office. Gout crystals have a needle-like shape, and are either yellow or blue, depending on how they are arranged on the slide .
Figure 11: Uric Acid Crystals Under Polarizing Light Microscopy
There are many circumstances where, however ideal it would be, no fluid or other specimen is available to examine, but a diagnosis of gout needs to be made. A set of criteria has been established to help make the diagnosis of gout in this setting .2
Table 1: Diagnosing gout when no crystal identification is possible
Ideally, 6 of 10 features will be present of the following:
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Video: An Exercise To Reduce Pain In The Top Of The Foot
This video demonstrates an exercise that can help reduce pain in the top of foot.
This exercise video is suitable for most people, but is not tailored to any specific condition, characteristic or person.
Get advice from a GP or health professional before trying it, especially if:
- you have any concerns about your health
- you are not sure if the exercises are suitable
- you have any pre-existing health problems or injuries, or any current symptoms
Stop the exercise immediately and get medical help if you feel any pain or feel unwell.
Signs And Symptoms Of Gout
Any joint can be affected by gout, but it usually affects joints towards the ends of the limbs, such as the toes, ankles, knees and fingers.
Signs and symptoms of gout include:
- severe pain in one or more joints
- the joint feeling hot and very tender
- swelling in and around the affected joint
- red, shiny skin over the affected joint
Symptoms develop rapidly over a few hours and typically last three to 10 days. After this time the pain should pass and the joint should return to normal.
Almost everyone with gout will experience further attacks at some point, usually within a year.
Read more about the complications of gout.
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Anatomy Of The Second Toe
The second toe consists of bones and joints. The 2nd metatarsal bone links your ankle with your second toe. The toe consists of three bones called the proximal middle and distal phalanx. Between the metatarsal bone and the proximal phalanx is the metatarsophalangeal joint. These joints have a thin joint capsule reinforced below by the plantar plate.
Effective Medical Treatment For Gout
The American College of Rheumatology released gout management guidelines in 2012 and updated them in 2020. They recommend drugs classified as urate-lowering therapy for those who have experienced two or more gout attacks in a year as well as for those with joint damage from gout.
Specifically, the organization recommends allopurinol as a first-line treatment for all gout patients, even those with chronic kidney disease. Next in line is febuxostat both are a class of drugs called xanthine oxidase inhibitors.
In addition, the guidelines recommend use of anti-inflammatory medications including NSAIDs, prednisone, or colchicine along with the other medication.
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What Can Increase Your Risk
A high level of uric acid in the blood is the main factor that increases your risk of developing gout. However, it’s still uncertain why some people with a high level of uric acid in the blood develop gout, while others with an equally high level don’t.
Other factors that may increase your risk of developing gout are outlined below.
When To See A Doctor
A bump on the top of the foot can cause pain and discomfort. If a person is having difficulty walking or the bump has reduced their quality of life, they should see a doctor.
If a bump on the top of the foot is getting larger or more painful, it is best to see a doctor to discuss possible complications and rule out any underlying health conditions.
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Most Common Gout Attack Sites
The most common site for a gout attack is what is known as the bunion joint on the big toe. It is typically the first joint affected by gout. As gout worsens, the ankle, mid-foot, knee, and elbow can become common sites of gout attacks. Uric acid crystals can also collect in soft tissues and form lumps called tophi, most typically on the hands, fingers, elbows, and ears.
What Are The Signs And Symptoms Of Gout
Gout flares start suddenly and can last days or weeks. These flares are followed by long periods of remissionweeks, months, or yearswithout symptoms before another flare begins. Gout usually occurs in only one joint at a time. It is often found in the big toe. Along with the big toe, joints that are commonly affected are the lesser toe joints, the ankle, and the knee.
Symptoms in the affected joint may include:
- Pain, usually intense
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How Will Gout Affect Me
Attacks can vary from person to person. Some people only have an attack every few years, while others have attacks every few months.
Without medication attacks tend to happen more often and other joints can become affected.
Having high urate levels and gout for a long time can lead to other health problems, including:
- narrowing of the arteries – which can lead to an increased risk of stroke or heart attacks or other heart problems
- osteoarthritis, which occurs when the urate crystals and hard tophi cause joint damage.
- an increased risk of developing kidney disease or worsening of the condition if you already have it
- kidney stones
- an increased risk of some cancers, especially prostate cancer
- mental health problems, including depression
- underactive thyroid
- erectile dysfunction in men.
If you take medication to lower your urate levels, and have a healthy diet and lifestyle, most of the damage and complications caused by gout can be stopped.
Treatments for gout are incredibly successful. There are two main parts to treating gout, which are:
- treating the acute attack
- treatments to prevent future attacks.
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.
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How Do You Relieve Pain On The Top Of Your Foot
Its important to seek treatment for pain in the top of the foot. Feet carry the bodys weight and any issue causing pain can worsen if its not addressed by a physician.
Treatment approaches for foot pain will vary depending on what the underlying diagnosis turns out to be, but there are several methods that are effective.
Treatment for top of foot pain can include some of the following:
The Four Stages Of Gout
Gout is best understood by seeing it as having four phases or stages :
Stage 1: High uric acid
Elevated uric acid without gout or kidney stone, this stage has no symptoms and is generally not treated.
Stage 2: Acute flares
This stage is marked by acute gout attacks causing pain and inflammation in one or more joints.
Stage 3: Intercritical periods
These are periods of time between acute attacks, during which a person feels normal but is at risk for recurrence of acute attacks.
Stage 4: Advanced gout
This is a stage of chronic gouty arthritis, in which there are lumps of uric acid, or tophi , frequent attacks of acute gout, and often a degree of pain even between attacks .
Figure 1: Stages of Gout
Figure 2: Illustration of Toe Joint with Gouty Tophus. normal toe joint Urate crystals, shown in white, at the “bunion joint,” represent a gouty tophus.)
Figure 3: Progression of Gout
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Lifestyle Changes Can Make Gout Attacks Less Likely
When you consider how much pain gout causes, it makes sense to try and prevent the problem flaring up. A key approach is to consume fewer foods and drinks containing high levels of purines, substances that lead to a uric acid build-up. A low-purine diet means avoiding beer, rich meats such as bacon, pork and liver, as well as many types of fish, seafood and shellfish.
The link between gout and over-indulgence is why the condition was known historically as the rich mans disease. Being a healthy weight, drinking plenty of water to flush out uric acid and exercising regularly can all help you to avoid gout attacks.