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.
Try Pain Medication Where Needed
If individuals are recovering from an injury to their ankles, they may want to try pain medication where needed. Over-the-counter pain relievers can also help chronic ankle issues. With that said, patients want to be careful what medications they take on a long-term basis, since prolonged use of certain ones can lead to kidney or cardiovascular damage. Ibuprofen can relieve fever, arthritis, and ankle cramps. It is a non-steroidal anti-inflammatory drug that thins the blood and blocks prostaglandins, which are substances that cause inflammation and swelling. Many individuals use it as a non-addictive alternative to heavier opioid medications.
Naproxen sodium also blocks prostaglandin production. However, it can cause kidney damage if used for prolonged periods. Acetaminophen is a fever-reducing medication that is also believed to reduce prostaglandin production, though the mechanism behind this has not been proven. These over-the-counter medications are typically enough to handle average soreness or pain from an ankle sprain. If an individual is experiencing more severe ankle pain, they can talk to a doctor about the potential for a prescription pain medication.
Reveal more options for relieving ankle pain now.
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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Lemon: Citric Acid Dissolves Uric Acid Crystals
Lemon is another fruit rich in vitamin C. It helps to heal sore joints as well as strengthens the connective tissues. Have a glassful of water added with lemon juice squeezed from half a lemon. Take it thrice a day.
Lemon juice consists of citric acid, which helps to dissolve uric acid crystals and prevent their deposition in the joints.
The Role Of Physical Activity In Prevention Of Gout
Along with diet, physical activity can help with weight loss, and gout has been associated with being overweight.7 in patients with well-established gout, especially if X-rays have demonstrated joint damage in the foot, a low-impact exercise program is reasonable. An exercise program combined with diet in gout can reduce risk for attacks.7 If an attack seems to be coming on in the lower extremity, patients are well-advised to try to get off their feet, since impact seems to worsen gout attacks. Clues to an attack of gout coming on include local swelling, heat, redness, and tenderness in a joint, especially in the foot, ankle, or knee. Some patients have fever and chills as the first warning that an attack of gout is coming on.
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What Are The Symptoms Of Gout In The Ankle
The main symptom of gout in the ankle is pain and discomfort in the surrounding area. Keep in mind that gout is often unpredictable, regardless of the joint its affecting. You might go weeks or even months without any symptoms, only to wake up with a burning pain in your ankle.
In some cases, gout starts out in one of your big toes before moving on to other areas, such as your ankle. Over time, these flare-ups may last longer than they previously did.
Other symptoms you might feel from gout in your ankle include:
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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When To Get Help For A Gout Flare
It’s always a good idea to let your doctor know that you are having a flare. Sometimes, you may need to follow up to make sure your treatment plan is working or if your symptoms don’t improve. Call your doctor if:
This is your first flare-up. There are several other conditions, such as a joint infection, that have some of the same symptoms as gout attacks.
You have a highfever and chills. Gout attack symptoms may include a mild fever, but a higher temperature may be a sign of an infection.
Your symptoms don’t get any better after 48 hours or don’t end after about a week. If you don’t start to feel somewhat better after a few days, call your doctor. They may suggest a different treatment. Most gout attacks will go away by themselves in several weeks, even without treatment.
Rebecca Manno, MD, MHS, assistant professor of medicine, division of rheumatology, Johns Hopkins University School of Medicine.
Robert T. Keenan, MD, MPH, assistant professor of medicine, division of rheumatology and immunology, Duke University School of Medicine.
Scott Zashin, MD, clinical professor of medicine, University of Texas Southwestern Medical School attending physician, Presbyterian Hospital.
Lan Chen, MD, PhD, attending rheumatologist, Penn Presbyterian Medical Center.
Gout and Pseudogout Treatment & Management: “Treatment.”
Johns Hopkins Arthritis Center: “Gout — Treatments for Gout.”
Merck Manual: “Gout.”
Common Myths About Gout
Drinking too much alcohol and eating too much rich food were once considered the prime suspects in causing gout. Although eating certain foods and drinking alcohol may cause uric acid levels to spike, these habits alone may not cause gout.
A recent study indicates that our DNA is a key factor in gout flare-ups. Researchers found that diet was less important than genetics in determining whether or not patients would develop high levels of uric acid.
If you suspect you have gout, make an appointment with your doctor to be tested and learn how to prevent or reduce future gout attacks.
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Pain Comes On Suddenly And Fiercely
Usually, when pain comes on suddenly, it’s something you can tracklike twisting your ankle or tripping. But there’s no rhyme or reason with gout.
You may feel perfectly healthy, and out of nowhere, gout strikes. “The symptoms usually come on fairly abruptly and worsen very quickly,” says Dr. Siaton.
The worst pain usually occurs within the first 24 hours. As mentioned, NSAIDs can relieve pain, but they are usually more effective if taken as soon as the pain hits.
Causes And Symptoms Of Ankle Gout
Similar to when gout develops in the big toe joint, gout of the ankle is caused by the buildup of uric acid in the body. This acid can crystallize in the joints, and these tiny structures can irritate joints and lead to a painful inflammatory reaction. Dietary choices typically increase your risk of developing gout. Foods like red meat, wild game and seafood all increase uric acid production in your body, as does a persons alcohol intake. Men are more likely to deal with excess uric acid, but after menopause its not uncommon for women to see an increase in their uric acid levels.
Symptoms of ankle gout include:
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Home Remedies For Long
The American College of Rheumatology recommends a couple of lifestyle modifications for preventing future attacks of gout:
1) Lose weight if you need to. Being overweight can increase uric acid levels as well as put pressure on the joints.
2) Follow a low-purine diet. Another effective way to reduce uric acid levels is to follow a low-purine diet. Purines are organic compounds that break down into uric acid. Following a low-purine diet means avoiding the big four alcohol, shellfish, red meat, and high fructose corn syrup.
Limiting these foods is also beneficial for heart health and people with gout are at higher risk for heart disease.
But dont go overboard with dietary changes to relieve gout pain though, advises Dr. Fields. You can find lists of thousands of different foods youre not supposed to have if you have gout. Those recommendations are impossible to follow and can make you crazy.
Topical Cold Or Hot Application
Applying cold or hot water to inflamed joints may also be effective.
Studies and opinions on this are mixed. Soaking in cold water is most often recommended and considered most effective. Ice packs may also work.
Soaking in hot water is typically only recommended when inflammation isnt as intense.
Alternating hot and cold applications may also be helpful.
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What Can Trigger A Gout Attack
Several things can cause the crystals to shake loose into your joint cavity, triggering an attack. These include:
- a knock or injury to the joint
- an illness that may make you feverish
- having an operation
- having an unusually large meal, especially a fatty meal
- drinking too much alcohol
- starting urate lowering therapy, especially at a high dose, or not taking your treatment regularly each day.
Range Of Motion Exercises For Gout
Range of motion exercises involve flexibility movements and stretching, and help joints function properly. These exercises are great for improving flexibility and preventing stiffness. You can do some basic movements at home such as rolling your shoulders back and forth.
- Yoga: Yoga is one of the best exercises for gout since it increases flexibility! Yoga involves a lot of stretching too, so it helps increase blood circulation improved blood circulation helps prevent uric acid crystals from forming. You can take a yoga class or find online tutorials.
- Qi Gong: Qi gong is a series of body movements that feature slow, gentle movements synchronized with your breathing, usually done while standing. Qi gong movements best for gout include lowering and squatting, raising and rotating the arms and bending to work the spine. You can take qi gong classes or find online videos such as this YouTube one to learn more about this ancient practice.
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Immediate Relief Expert Care
Gout pain in your toes and feet can be extremely uncomfortable. While these home remedies may offer temporary relief, you might need professional care.
If you begin fevering, this is often a sign of infection. Dont wait to come in.
Weve got a full team ready to help, right away. Visit our contact page to make a quick appointment or give us a call today at 239.936.5400.
How Is Gout Managed
Here’s the truth: there is no cure for gout, although there are many ways to treat it and prevent flare-ups.
Oddly enough, some people only have a gout flare-up once, while others have flare-ups more often.
So how might you avoid future flare-ups? It makes sense to avoid high-purine foods, but eating a purine-free diet is pretty hard to do.
And though elevated uric acids are a precursor to a gout attack, having high levels doesn’t mean you’ll automatically have an attack. Still, eating and drinking excessive amounts of high-purine foods isn’t good for anyone.
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Arthritis / Acute Gout Attack
Gout is a form of arthritis, hence it causes pain and discomfort in the joints. A typical gout attack is characterized by the sudden onset of severe pain, swelling, warmth, and redness of a joint. The clinical presentation of acute gouty arthritis is not subtle with very few mimics other than a bacterial infection.
The joint most commonly involved in gout is the first metatarsophalangeal joint , and is called podagra. Any joint may be involved in a gout attack with the most frequent sites being in the feet, ankles, knees, and elbows.
An acute gout attack will generally reach its peak 12-24 hours after onset, and then will slowly begin to resolve even without treatment. Full recovery from a gout attack takes approximately 7-14 days.
An accurate and colorful discription of a gout attack was elegantly written in 1683 by Dr. Thomas Sydenham who was himself a sufferer of 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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Who Is At Risk For Gout
Anyone can be affected by gout.
Gout is most common in middle-aged men, especially those with a family history of the disease. Women can get gout, too, most often after menopause.
Your chances of developing gout are higher if you:
- Are overweight
- Drink too much alcohol, especially beer
- Eat a diet rich in meat and fish, which can be high in chemicals called purines
- Take certain medicines, like water pills , that can trigger an attack
Recent research also indicates that genetics may play a big role in determining who gets gout. Ask your doctor if you have questions about your risk for developing this condition.
Gout In The Ankle Symptoms & Treatment
The onset of pain in the ankle joint pain is usually at night when the body temperature is lower. Many times it is accompanied by fever and fatigue.
The attack usually lasts for 3 to 10 days when treated properly and in 50% of cases it recurs within a year. If ankle gout is ignored and not treated properly the number of urate crystals increases damaging the joint and soft tissues around it. Eventually, tophi nodules are formed and slowly kidney failure also takes place.
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Preventing And Treating Gout
When you first come to AllCare Foot & Ankle Center with gout symptoms, we conduct a thorough examination to determine the best course of treatment. We typically prescribe nonsteroidal anti-inflammatory medications to help control symptoms and prevent further joint damage.
If youve already had or continue to have multiple gout attacks, it can lead to a variety of health complications, including the erosion and destruction of your toe joint and the development of kidney stones. This is why preventing future gout attacks is essential for your overall health and wellness, not just for relieving the pain in your toe.
We recommend the following to help prevent future gout flare ups:
- Drink plenty of fluids
- Limit or avoid alcoholic drinks
- Reduce meat, poultry, and seafood in your diet
- Consume more low-fat dairy products for protein
- Lose weight, if necessary
The common symptoms of gout arent something you should ignore, and we can help you get it under control. Give us a call at our Arlington or Dallas offices, or request an appointment online today.
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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 don’t 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.
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