Diagnostic Evaluation Of Gout In Foot
What goes into a gout diagnosis? These procedures are options:
- Joint aspiration. Fluid is withdrawn from the joint and inspected for crystals and bacteria.
- Blood tests. White blood cell count, ESR , triglycerides, and kidney function may be elevated.
- X-ray. An x-ray of the affected joint is likely to appear normal during an initial acute episode, but in chronic gout, bone erosion and overhanging edges may be seen.
Who Gets Ankle Gout
So why is this old disease coming back to life, and who is at risk for it?
Whether gout strikes your foot, ankle, hand, or other joint, the recent spikes in gout could be due in part to weight gain.
A March 2021 study published in Arthritis Research and Therapy revealed gaining weight through adulthood was associated with a higher risk of gout.
An earlier study, published last year in Arthritis & Rheumatology, discovered overweight people were 85 percent more likely to have higher levels of uric acid than people who were at a healthy weight.
Here are some other things that make you more likely to get gout:
- Genetics, especially if a first-degree relative has gout
- Being male
- Being postmenopausala decline in female sex hormones reduces protection against elevated uric acid levels
- Regularly eating and drinking high-purine foods, like veal, bacon, turkey, venison, liver, trout, codfish, anchovies, sardines, herring, haddock, scallops, muscles, liquor, beer, wine, and high-fructose beverages
- Having a chronic health condition, such as diabetes, congestive heart failure, and high blood pressure. Chronic kidney disease is a big risk factor because the kidneys dont work efficiently to filter uric acid out of the body
- Taking medications that can lead to higher uric acid levels, such as diuretics and immunosuppressants
Certain ethnicities, especially people who are Black, have a higher prevalence of gout and are less likely to receive the proper care and treatment.
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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You never forget your first gout attack. The severe pain, swelling, and redness hits hard and fast. The initial attack often strikes your big toe’s large joint, but later ones might affect the foot or ankle. Other hot spots include the knees, hands, and wrists.
First-line treatment is quite effective and includes anti-inflammatory medications, ice therapy, and rest. A combination of diet and lifestyle changes and prescription drugs an approach called urate-lowering therapy, or ULT is typically recommended if attacks recur or become more severe.
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How To Know If Your Gout Is Progressing
As you become more familiar with gout symptoms, you may be able to sense that a gout attack is coming on. Worsening of pain, swelling, redness, and warmth of the affected joint during the attack is the sign of progression of that attack, Dr. Meysami says.
In addition, the disease overall may progress with recurrent or more frequent gout attacks with longer duration, the involvement of more joints, and the presence of tophi, Dr. Meysami says.
If you have more than one gout flare a year, its really important to get on a regular gout medication, says Dr. Fields.
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Treatment For Ankle Gout:
Surgery For Arthritis In The Ankle
Your doctor may recommend surgery for your ankle arthritis if your pain causes disability and isnt relieved with nonsurgical treatment. Your doctor may recommend more than one type of surgery. Ankle surgery is complicated as it most commonly involves a fusion of the rearfoot or ankle joint or both, says Dr. Archer. If there is significant spurring of the ankle joint, the spurs can be resected via ankle arthroscopy first before fusion is attempted to try and restore ankle motion. However, all non-surgical measures should be attempted before surgery is planned.
Whats right for you depends on the extent of your arthritis in the ankle. Here are some options.
Ankle arthroscopic repair: Ankle arthroscopy is useful to clean up loose joint bodies, or small pieces of bone spurs in the joint that have broken off over time, says Dr. Archer. It can lead to less pain and improved range of motion, says Dr. Bilal. Since the surgery can be done laparoscopically, your surgeon will make a few small incisions.
Ankle arthroscopic repair is helpful in the early stages of arthritis in the ankle and for those with limited ankle arthritis. Its often ineffective in advanced ankle arthritis, says Dr. Bilal. Thats because when a significant amount of cartilage has worn away, the procedure wont help the joint.
Dr. Archer says that you shouldnt expect to walk as you once did. But if the pain is bad enough, you may welcome the chance to walk slightly differently without pain.
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Other Symptoms Of Gout Include:
While visible symptoms and painful joints are key symptoms of gout, high levels of uric acid can also present itself in different forms.
Speaking exclusively to Express.co.uk, Dr Sumera Shahaney, GP and Head of Clinical Operations at Thriva said: High uric acid levels are also associated with kidney stones, of which the symptoms include: pain and aching in your lower back, abdomen, or groin, foul-smelling urine thats painful to pass and feelings of nausea.
If you suspect you have gout you should always reach out to a medical professional for advice or treatment.
The Pathology Of Gout
Gout is primarily a metabolic disorder in which uric acid accumulates in blood and tissues. When tissue levels reach saturation, needle-like crystals form, causing inflammation. This occurs most commonly in the cooler joints, notably the metatarsophalangeal joint of the big toe.
Many people with hyperuricemia never develop gout, but those with the highest levels are most likely to suffer episodes. Hyperuricemia may also lead to kidney stones.
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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.
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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Take Caution With Supplements For Gout
As for the many supplements and other purported home remedies available for gout, including turmeric and bromelain, there is no significant evidence backing them up as of now, and theres no adequate evidence showing that supplements have any effect even comparable to that of medicines.
From my point of view, says Dr. Fields, the home remedy concept to gout is often harmful because it keeps patients from taking medications that we know are effective.
Podiatrists Located In Festus Mo & St Louis Mo
If you wake up in the middle of the night feeling like the weight of your bedsheets is too much to bear on your big toe, you likely have gout. It might also feel like your toe is on fire. Franklin Harry, DPM, ABMSP, and Tim Davydov, DPM, of Best Foot Forward in Festus and St. Louis, Missouri, use gout treatment to put out the fire sensation in your toe. Call Best Foot Forward today or book an appointment online to find relief from your gout symptoms.
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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.
What Are The Risk Factors For Gout
Risk factors for gout include:
- being male
- taking medications that increase water excretion by the kidneys
- being overweight
- eating a diet with a lot of meat, offal and shellfish
- having kidney disease, high blood pressure, diabetes or abnormal levels of fat and cholesterol in the blood
- drinking a lot of alcohol, especially beer, port or spirits
- going on a crash diet or fasting
- being of Maori or Pacific Islander origin, which can predispose a person to high uric acid levels
Gout is more common in men than in women, and among women it’s more common after menopause. It’s more likely to occur in older people, but can affect anyone.
It can also affect people with certain types of blood disorder and people in treatment for cancer.
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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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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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Diagnosing And Treating Ankle Gout
If youre experiencing one or more of the symptoms listed above, consider heading to an ankle and foot specialist to get an official diagnosis, especially if you are trying to rule out other issues or you have underlying health issues that could complicate treatment. If youre otherwise healthy and have a strong suspicion that gout is the problem, you can also try some of the conservative treatment techniques well talk about below from the comfort of your home.
During your diagnostic exam your doctor will conduct a physical exam of the ankle and ask you to perform some manipulation exercises to check your range of motion. Theyll also review your medical data and ask you a few questions about your diet and any medications you take. They can oftentimes make a determination after the physical exam and questions, but a blood test can be used to confirm high levels of uric acid in the body. Imaging tests for gout are rare, but can be effective.
There arent any specific exercises that target ankle gout like there are for other foot conditions, and general exercise for weight control is considered the standard. However, if a flareup makes running or walking uncomfortable, strive to do some limited weight bearing exercises like cycling or swimming.
If you follow these tips and work with a professional, were confident you can get your gout under control. For more information or for help with your condition, reach out to Dr. Silvermans office today.
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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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
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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