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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 I Do Anything At Home To Relieve Gout Pain
Besides seeing your podiatrist, there are things you can do to ease the pain and swelling caused by gout. Raise and rest the affected limb, and use a splint to immobilize the joint. Also, do not exercise vigorously. Try keeping the joint cool by applying an ice pack wrapped in a towel. Remember, dont apply cold items directly onto the skin. Lastly, do not cover the joint.
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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How Does Gout Affect The Feet
There are more than 100 different types of arthritis, but they all boil down to one thing joint pain and inflammation. In this regard, gout is no different, but its unique in that it can cause stabbing pain in your feet and ankles during a flare-up.
The team of highly qualified musculoskeletal experts here at Western Orthopaedics has you covered from head to toe and toe is an appropriate usage here as gout most often strikes your big toe.
Heres a closer look at gout, how it affects your feet and ankles, and what we can do to manage the problem.
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
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Factors Influencing Crystal Deposition
Gout is one of the best understood inflammatory arthropathies. Clinical features can be easily understood and interpreted in the context of a clearly elucidated pathogenetic process. Specific risk factors such as genetics, dietary factors, co-morbidity and its treatment lead to hyperuricaemia and subsequently MSU crystal formation occurs . Crystals are then shed into the joint and activate the inflammatory cascade via the NALP3 inflammasome . Hence, any explanation of why gout targets the foot must link these pathological processes to the specific anatomical, functional, and disease characteristics of the foot .
Processes enhancing MSU crystal formation and deposition at the first MTPJ.
Signs Your Pain Is Likely Gout And Not Something Else
If you develop sharp sudden pain in a single joint or a couple of joints, if the pain is so debilitating that it is hard to walk or wear shoes, and if you have risk factors for gout , theres good reason to suspect gout as the culprit. However, its important to see a doctor for a thorough exam and proper diagnosis.
Dr. FitzGerald cautions that issues unrelated to gout can cause an angry, inflamed joint. Gout may be confused with several other conditions that can cause similar symptoms, including:
- Pseudogout
- An infected joint
- Bacterial skin infection
- Rheumatoid arthritis
- Psoriatic arthritis
Pseudogout is caused by a different kind of crystal, calcium pyrophosphate. A flare of pseudogout can resemble gout, but it more often affects your wrist and knee, and is unlikely to involve the big toe. Like gout, pseudogout is also considered a form of inflammatory arthritis. Its more likely to affect people over the age of 40 and those who have a thyroid condition, kidney failure, or disorder that affects calcium, phosphate, or iron metabolism, according to the Cleveland Clinic.
Its also possible to have gout without the classic presentation of red, hot, sharp, burning, sudden pain in the big toe, foot, ankle, or knee. Some patients may have joint pain that is less acute.
People can also have high levels of uric acid but not develop symptoms of gout.
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Preventing Future Gout Attacks
Maintaining more alkaline body chemistry is the way to avoid gout symptoms in the hands after the current attack has been extinguished. While the viable methods vary, common to all of them is good breathing and blood oxygenation, consistent hydration, and a healthy diet of mostly alkaline-forming foods fresh fruits and vegetables.
Avoiding all types of processed foods and fast foods is mandatory as they are one of the sure causes of gout.
Remember! The symptoms of gout in the hands have to be dealt with as soon as they present themselves.
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
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How Does Sugar Affect People With Gout
High intake of fructose and sugary foods may have an effect on uric acid levels in the body. One reason is sugar and sweets are higher in calories and linked to obesity, a known risk factor for gout.
In addition, although fructose-rich beverages, such as soft drinks, dont contain high amounts of purines, they have been shown to increase the risk of developing gout. This is because uric acid is one of the byproducts of fructose metabolism. Evidence has shown consuming high amounts of fructose may increase uric acid levels in the blood.
Increasing your daily water intake and cutting soft drink and soda consumption will help to flush your body of uric acid and prevent the formation of kidney stones.
Though theyre tempting, sweets are better left untouched. Make room instead for healthier, gout-friendly foods such as plant-based proteins and low-fat dairy products.
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
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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.
Now Its Your Turn To Understand What Part Of The Foot Does Gout Affect
Theres now thousands of us who no more endure gout because we tackled it at its cause. Instead of just tinkering with the symptoms.
Im one of them.
Remember, I got gout for the same reasons you own it right now.
An poor gut microbiome supposed that bacteria which should have been getting rid of a 3rd of my bodys uric acid basically wasnt.
That bacteria possessed diminished to the stage that my kidneys were trying to cope with the acid on their own.
And they couldnt cope.
Nor can yours.
It wasnt which i was suddenly delivering an excessive amount of uric acid. Its that my gut was no longer in a position to aid my kidneys take it off from my own body.
And the transformation from gout to no gout felt like magic almost.
You can possibly imagine it yourself.. what it would be like to simply never have any gout ever again.
Take my word for it, its wonderful!
No flare-ups, no pain, no being laid-up in bed for days waiting for the pain to subside.
No wanting to know if some future function will be smudged because Im laid up in agony with another strike.
Just as pleasing is that Ive in addition considerably lowered my risks of battling diabetes, kidney failure, heart disease and some cancers.
Shellys program lays it all out for us. No special knowledge is required. I found it easy.
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What Does It Mean When Your Foot Arch Hurts
Plantar fasciitis is the most common cause of arch pain and one of the most common orthopedic complaints reported. Its caused by inflammation, overuse, or injury to the plantar fascia. The plantar fascia is the ligament that connects the front of your foot to your heel.
Choose The Right Footwear
Because gout often affects the big toe, midfoot, and ankle, choosing good footwear is important. Dr. Iversen says a physical therapist can help evaluate the best footwear for a patient with gout based on evidence that shows specialized footwear provides benefits for patients by changing the alignment of the leg and foot, influencing the activity of the muscles of the foot, and your gait pattern . These modifications are designed to decrease the pressure on your joints.
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Is It Possible To Have Gout On Both Feet
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Neuropathy Started During A Gout Spell
Ok, my neuroaphy started during a gout attack. It started in my toes and spread to my feet and hands within a few weeks. I never had it before and the Dr. continue to say I am not diabetic. I was is good health up to that 3 week point never having it before. The treated the gout with Colchicine, steroids and allopurinol during the 3 week time. I have every blood test known with no direct cause. I have some RA factor but not enough for clear diagnosis of RA. Seen a neurologist and dont have permanent damage yet but have flares from food and sometimes without. I ate a single chocolate cookie last night and now my feet are on fire along with arms hands and legs. No DR can figure this out, seems like something attacked my nerves during the treatment. Can it be something attacking nerves and why can we not find the connection between sugar and the neuropathy. Anyone that has some idea i am open to anything.
Hello , welcome to Mayo Clinic Connect. I’ve never heard of gout causing neuropathy but I have had several occurrences of gout in my right foot which went away fairly quickly when treated with Colchicine. I do have idiopathic small fiber peripheral neuropathy with only numbness, no pain. I did find a very short article that was interesting on the National Institutes of Health site and the Journal of the American Medical Association site..
NIH â Gouty neuropathy
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Causes And Risk Factors
Gout occurs due to an excess buildup of uric acid, or hyperuricemia.
According to the National Institutes of Health , hyperuricemia is the main risk factor for developing gout. However, a quarter of those with hyperuricemia do not develop gout.
When the body breaks down purines, it produces uric acid. Typically, the kidneys remove a certain amount of uric acid in the urine. However, when they are unable to remove enough uric acid, uric acid crystals can form in the joints and soft tissues, causing swelling and pain.
Gout typically affects males more than females. However, females have higher levels of uric acid after menopause. NIAMS state that being older also the chance of developing gout.
Genetics can also increase the chance of developing gout.
According to the CDC , other factors that may increase the likelihood of gout include:
- Diet: Food can play a role in the development of gout symptoms. Eating seafood, red meat, and drinking alcohol raises uric acid levels in the body.
- Weight: Having overweight increases the chance of developing gout.
- Medications: Certain medications, including diuretics and low-dose aspirin, are associated with gout risk because they increase the level of uric acid in the body.
- Other medical conditions:High blood pressure, diabetes, and kidney disease can increase gout risk.
According to the National Health Service in the United Kingdom, some people with gout may develop complications, such as:
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.
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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 .