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Gout In Foot And Ankle

The Pain And Swelling Of Gout Can Be Easily Treated

Gout of the Foot and Ankle

IBJI

October 17, 2012 | Blog

Gout is actually a form of arthritis that commonly affects the big toe in men. It may cause a sudden burning pain in one of your joints, or stiffness and swelling in one or more joints. Attacks of gout can happen repeatedly unless it is treated. Eventually, gout attacks can cause long-term damage to your tendons, joints, and soft tissues.

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.

Contents

Why Does Gout Flare Up

Gout, one of the dozens of forms of arthritis, flares up when uric acid crystals develop in your joints. Uric acid crystals form when purines metabolize improperly. Although your body normally flushes away uric acid through waste, poor kidney function and having a diet high in purine-rich foods alcohol, red meats, and shellfish, among others can cause uric acid levels to surge.

The reason uric acid tends to accumulate in your lower extremities is that your feet, particularly your toes, are the furthest points from your heart. This means circulation is limited.

Plus, uric acid tends to crystallize in cooler temperatures. Because of the decreased blood flow in your feet, your toes are often the coolest points in your body. This is why gout tends to flare up most commonly in your feet and ankles, although technically gout can affect any of the joints in your body.

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What To Do During An Attack

You should:

  • take any medication you’ve been prescribed as early as possible after you notice an attack this should start to have an effect within two or three days
  • rest and raise the limb
  • avoid knocking or damaging the affected joint
  • keep the joint cool remove surrounding clothing and apply an ice pack, such as a bag of frozen peas wrapped in a towel
  • ensure you’re well hydrated

Apply the ice pack to your joint for around 20 minutes. Don’t apply ice directly to your skin and don’t apply it for more than 20 minutes at a time because this could damage the skin.

If necessary, you can keep reapplying an ice pack to your skin during an attack, but you should wait until your skin has returned to a normal temperature first.

Preventing Future Ankle Gout Symptoms

Panel Issues Consensus Statement on Management of Gouty ...

After surviving an arduous bout of gout ankle, keeping the body in a state of greater health by keeping the body chemistry on the more alkaline side is wise. Minimizing the causes of gout can be done in several ways:

  • Strong breathing awareness and habits keep the blood healthy and oxygenated
  • Maintaining consistent hydration is essential for proper pH balance
  • A diet of alkalizing foods, and foods that support strong kidney and liver function is fundamental
  • Managing stress is important for minimizing the effects of acid-forming hormones in the inner terrain
  • Being aware of, and avoiding toxic environmental chemicals is a good way to retard the slow accumulation of low-level toxicity from seemingly mundane household products
  • Consistent exercise and sleep are the basics to health, and obvious and easy measures to employ for guarding against the risk of gout

Remember! When symptoms of gout in the ankle start to become apparent, it is critical to take fast action.

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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.

Gout In Ankle: Causes Symptoms Treatment And Prevention

Written byEmily LunardoPublished onNovember 10, 2017

Gout in the ankle or ankle gout is an inflammatory condition of the joint leading to swelling, pain, and redness of the ankle. Gout is a complex form of arthritis that can affect anyone, with over eight million Americans suffering from the condition today. Men are typically affected more, but postmenopausal women become increasingly susceptible in their later years.

The most common joint affected by gout is the big toe, but joint pain may also be experienced in the knees, hands, ankles, and wrists. Having gout in the ankle can be very debilitating as it encumbers your ability to walk normally.

This article will answer the question what causes gout in the ankle, giving you a better understanding of the intricacies of the condition to better treat it.

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Potential Treatments For Gout In The Foot

There are two basic methods of combatting gout or gouty arthritis as is its full term you either stop the pain of a gout attack or you take steps to prevent a future attack happening.

These are typically broken down as follows

Stopping Gout Pain

  • Dietary Change
  • Massage
  • What I want to do now is look very specifically at what you need to do to apply each of the above and achieve better treatment for gout in the foot

    Do You Want Crystals In Your Toe

    Gouty Arthritis in Foot and Ankle – Causes, Symptoms & Treatment

    Gout can be even more painful than other forms of arthritis, and theres a good reason why. In addition to stiff, inflamed joints, gout sufferers have to soldier through another insult: crystals in their toes.

    When you consume foods that contain purines, your body breaks the purines down into uric acid. But, if you eat too many purines, your body cant process all of the uric acid. The leftover acid crystallizes and settles in the tissues of your big toe joint or other joints in your foot, ankle, or knee. The uric acid crystals feel like sharp pins and needles.

    To avoid adding more crystals to your collection, its important to modify your diet so that you minimize the amount of purines you consume.

    Cut down or cut out the following high-purine foods:

    • Processed meats
    • Eggs
    • Low-fat dairy products

    You can also eat one serving of lower-purine meat several times a week, choosing from salmon or unprocessed meats like beef, poultry, pork, and lamb.

    Studies demonstrate that drinking 1-3 cups of coffee per day may help prevent gout attacks. Be sure to ask Dr. Frazier about a calcium supplement if youre at risk for osteoporosis, because caffeine depletes calcium.

    Also be sure to drink plenty of water, which dilutes your urine so your body can process uric crystals more easily. And if you have a gout attack, grab a handful of cherries, drink 100% cherry juice, or take a vitamin C supplement.

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    What Happens At Your Appointment

    The GP may ask about your diet and if you drink alcohol.

    They may refer you to see a specialist and arrange a blood test and scan. Sometimes a thin needle is used to take a sample of fluid from inside the affected joint, to test it.

    The blood test will find out how much of a chemical called uric acid there is in your blood.

    Having too much uric acid in your blood can lead to crystals forming around your joints, which causes pain.

    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

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    How Do I Know If I Have Gout

    The symptoms and signs of gout are usually acute, they appear suddenly without warning. A lot of the time the attack will occur at night. There are many symptoms of gout:

    • Sharp, severe pain in the joints: This pain can be experienced in the hands, wrists, ankles, knees or feet. The big toe is most commonly affected. Sometimes patients describe the area as being warm or hot. Inflammation can also occur.
    • Gradual decrease in pain: This type of arthritis can last for over a week if its untreated, then usually goes away within the next week or two.
    • Peeling, itchy skin: As gout gradually subsides, the skin near the affected area may begin to itch and peel.
    • Inflammation and redness: Gout usually causes tender, swollen and red joints in the area thats experiencing the most pain.
    • Purplish or red colored skin: This may cause the patient to think he or she has an infection.
    • Fever: In some cases, gout can cause body temperature to elevate.
    • Decrease in flexibility: The joint affected could feel harder to use, or have limited movement.

    How Is Gout Treated

    Gout Foot Model

    Changes in diet and avoiding foods with high purine content reduces the inflammation and pain associated with gout. Your doctor may prescribe nonsteroidal anti-inflammatory drugs to reduce swelling, such as one of the following:

    • allopurinol
    • pegloticase

    Most people who suffer from gout attacks must take medication going forward.

    If your doctor prescribes colchicine to prevent gout attacks and you have an attack while taking the drug, the attacks will return when you stop. If you are given allopurinol in order to reduce the blood’s uric acid levels or to reduce urine’s uric acid levels , stopping treatment brings risk of attack and disease back up.

    Whether you’re taking medication for your gout or not, it’s vital to limit your intake of foods high in purines. Studies have shown that even when medications fail to work, changing a patient’s diet can significantly reduce the number of gout attacks they experience.

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    Causes Symptoms And Treatment Options For Gout Of The Ankle

    Weve discussed gout of the toe joints on the blog in the past, but thats not the only area of your body that can be affected by this inflammatory condition. In fact, another common location for gout problems is in your ankle joint. Below, we take a closer look at why gout develops in the ankle and how you can best treat the condition.

    What Can I Do To Avoid Gout Attacks

    Once we take care of your current gout attack pain, we will likely refer you to your primary care physician so they can consider medication to prevent future gout attacks. These medicines can wash the uric acid from your joints, reduce swelling, and keep uric acid from forming. We also recommend, if you are overweight, to shed excess pounds. If you have high blood pressure or high cholesterol, get treatment and follow a low-salt, low-fat diet. Stay away from alcohol and foods that are high in purines. And be sure to drink lots of water it can help flush uric acid from your body.

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    What Are Future Possible Treatments Of Gout

    Fortunately, present medications are successful in the vast majority of gout patients. But some patients cannot tolerate our present arsenal of gout medications. For others, these agents are not sufficiently effective. Therefore, new treatments are continually being sought. Some of the more promising include anakinra, rilonacept, canakinumab, BCX4208 and arhalofenate.

    The Role Of Medication In Prevention Of Gout

    Treatments for Gout by Dr Matt Ahmadi at Orange County Foot and Ankle

    Table 3: Medications to pevent attacks of gout

  • Colchicine: to decrease the ability of uric acid crystals to cause inflammation.
  • Allopurinol and febuxostat: to decrease production of uric acid
  • Probenecid and lesinurad: to increase the excretion of uric acid
  • Pegloticase: to increase the breakdown of uric acid
  • 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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    Who Is Most At Risk For Gout

    Men are 300% more likely than women to be diagnosed with gout. However, people with one or more of the following conditions are at a higher risk than average.

    • diabetes
    • high triglycerides
    • obesity

    In a nutshell, you’re more likely to develop gout if you have high levels of uric acid in your body. The following factors can increase the uric acid level in your body so managing these factors well can help mitigate your risk for gout.:

    How Is Gout In The Ankle Diagnosed

    If you think you might have gout but havent been diagnosed, try to see a doctor while youre having symptoms. Gout is easier to diagnose when youre in the middle of a flare-up thats causing swelling, redness, and other visible symptoms.

    During your appointment, your doctor will likely ask you several questions about your diet, any medications you take, and whether you have a family history of gout. This can help to rule out other potential causes of your symptoms, including an infection or rheumatoid arthritis.

    Your doctor may also order a blood test to check your uric acid levels. But some people have high levels of uric acid and dont develop gout. Others have typical uric acid levels but still develop gout. As a result, theyll want to do some other tests as well.

    An X-ray, MRI, or CT scan of your ankle can also help to eliminate other possible causes of joint inflammation. Depending on your exam, they may also order an ultrasound to check for the presence of crystals in your ankle.

    Finally, they might do a joint fluid test. This involves taking a small sample of joint fluid from your ankle with a small needle and looking at it under a microscope for any uric acid crystals.

    Based on the results of your exam and tests, they may refer you to an inflammatory arthritis specialist called a rheumatologist for treatment.

    Theres no cure for gout, but a combination of medications and home treatments can help to manage ankle pain and reduce the number of flare-ups you have.

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