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.
What Does The Future Hold For Gout
Active research is ongoing in a variety of fields related to gout and hyperuricemia. Scientists have found that high animal protein slightly increased the risk for gout. New drugs are being developed that may be more versatile and safe in treating the elevated uric acid levels in patients with chronic gout.
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What Does Gout Look Like In Your Ankle
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Symptoms Of Gout In The Ankle
Gout symptoms are on a whole other level compared to a sprained ankle, cellulitis , tendonitis, or other ankle issues.
“The gout symptoms such as acute swelling/pain and erythema are typically much more severe,” says Dr. Seligman. “This is much different than chronic weakness or swelling.”
Seeking medical attention sooner than later is always recommended to get the pain under control.
Before we dive into the symptoms of ankle gout, know this: you shouldn’t use these symptoms to self-diagnosis ankle pain.
Always see a doctor when you have one of the symptoms or a combination of the following symptoms.
Who Is Affected By Gout
Gout can affect anyone. It usually occurs earlier in men than women. It generally occurs after menopause in women. Men can be three times more likely than women to get it because they have higher levels of uric acid most of their lives. Women reach these uric acid levels after menopause.
People are more likely to get gout if they have:
- Obesity, or a lot of extra weight.
You are also more likely to develop gout if you:
- Consume a diet high in animal proteins
- Consume a significant amount of alcohol
- Are on water pills .
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Whats The Outlook For People With Gout
Untreated gout can lead to permanent joint damage. The buildup of uric acid in the joints and soft tissue is called tophus. Some people with gout can also develop other health problems, such as severe arthritis, kidney stones and heart disease. Its important to discuss your symptoms with a healthcare provider.
The Role Of Uric Acid
Uric acid is produced when your body breaks down purines, which are substances naturally found in your body, as well as in protein-rich foods. At normal levels in your blood, uric acid is a powerful antioxidant and does not cause any damage. The body keeps uric acid at a set level by excreting it through the kidneys and in urine.
It is possible to have hyperuricemia and not develop gout. About two-thirds of people with elevated uric acid levels never have gout attacks. It is not known why some people do not react to abnormally high levels of uric acid.
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Southern Cross Medical Library
The purpose of the Southern Cross Medical Library is to provide information of a general nature to help you better understand certain medical conditions. Always seek specific medical advice for treatment appropriate to you. This information is not intended to relate specifically to insurance or healthcare services provided by Southern Cross. For more articles go to the Medical Library index page.
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Clinical Presentation Of Gout And Involvement Of The Foot
After an often prolonged period of asymptomatic hyperuricaemia, the initial manifestation of gout is usually an acute attack of synovitis affecting a single peripheral joint, most commonly the first metatarsophalangeal joint . Other commonly affected joints include the mid-tarsal joints, ankles, knees, fingers, wrists and elbows .1). Such attacks are characterised by sudden onset of excruciating joint pain, typically taking less than 24 hours from symptom onset to reach peak intensity, with associated joint swelling, overlying erythema and exquisite tenderness to touch. Although acute gout should be treated rapidly with a non-steroidal anti-inflammatory drug or colchicine, it usually resolves completely over a period of two to three weeks even without treatment. A variable period of time then elapses until the patient experiences a further attack . With time, attacks may increase in severity and frequency, involve different joint sites, and may become oligo- or polyarticular. Eventually, without treatment, the patient may develop chronic tophaceous gout, characterised by chonic pain and stiffness, joint damage and erosive arthropathy, and clinically evident subcutaneous nodular deposits of MSU crystals which can occur at the toes, Achilles’ tendons, pre-patellar tendons, fingers, olecranon processes, and less commonly, the ears .
Tophaceous gout affecting the right great toe and finger interphalangeal joints. Note the asymmetrical swelling and yellow-white discolouration.
What Severe Gout Looks Like
In more severe cases, you might see a huge lump around the affected joint. This is called tophi, and if you are not careful, your gout condition could develop into this. Tophi means theres already uric acid deposits in the joints, and it can be extremely painful. There are drugs that can help dissolve tophi in joints but sometimes surgery is already needed to remove it because it might hinder the patient’s ability to move normally. Tophi might also have to be drained and treated with antibiotics if it gets infected.
Once removed, tophi looks like whitish or yellowish deposits. Gout patients can experience great relief once tophi is removed, but this does not completely solve their problem, as uric acid crystals can build up again in the area. If the patient’s lifestyle remains the same, gout eventually impacts not just the joints, but the tendons and other tissues as well.
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They Might Be Discolored
You may notice looking at the color of the skin on the hands, that it is yellowed. In fact, the skin all over the body may be yellow, even the whites of the eyes. This is jaundice and is a sign of liver, gall bladder or pancreatic disease.
Cold, pale, puffy hands may be a sign of an underactive thyroid gland.
Anemia may also cause the palmar skin creases to look pale, instead of pink.
Liver disease causes bright red palmsliver palms.
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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 .
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How Can An Attack Of Gout Be Treated
The management of an acute attack of gout is very different from the prevention of subsequent attacks.
Treatments used for prevention, such as allopurinol can actually make things worse if given during an attack, and so need to be held back until the attack has resolved for several weeks.
There are a number of measures that can help resolve an attack of gout. See Table 2 for summary of treatment strategies for acute gout. One principle is that treatment for an attack of gout should be instituted quickly, since quick treatment can often be rewarded with a quick improvement.
If an attack of gout is allowed to last more than a day or so before treatment is started, the response to treatment may be much slower.
Table 2: Medications to treat acute attacks of gout
What Is Gout Its Causes
Gout is actually a type is arthritis that happens due to hyperuricemia, a condition where blood uric acid level increases more the normal level. So, what happens when uric acid increases in our body?
Uric acid present in the blood gets ionized into Monosodium Urate Crystal. Normally these urate crystal gets dissolved and its solubility is affected by:
- Synovial fluid pH,
- Electrolytes level, and
- Other synovial components such as proteoglycans and collagen.
But, when the level of uric acid increases the urate crystal starts deposition gets starts in the tissue around the joints leading to gout. There are two factors that causes the increase in the uric acid level one is overproduction of uric acid and second condition is when there is decreased excretion of uric acid from the body.
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You Might Have A General Medical Condition
Anaemia may cause nails to be brittle or even spoon-shapedkoilonychia. This can be a sign of celiac disease, diabetes, vitamin B12 deficiency or haemochromatosis .
Diabetics may have a condition known as cheiroarthropathy. In this condition hands and fingers are stiff. If you put your two palms together and straighten your fingers as much as possible, you will not be able to touch the full length of each finger together.
Half and half nails are a rare but pathognomonic sign of kidney failure. When they occur the proximal part of the nail near the nail bed is pale or white, and the distal part of the nail is brown.
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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.
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Acute Attack Pain Management
Home remedies. Reducing inflammation during an acute gout attack will provide pain relief.
- Ice. Apply ice to the affected area to reduce swelling. Do not apply ice directly to the skin. Use an ice pack or wrap a towel around the ice. Apply ice for about 20 minutes at a time.
- Elevate. Frequently raise and keep the affected area above the level of the heart.
- Rest. Move the affected area as little as possible while symptoms are present.
- Over-the-counter non-steroidal anti-inflammatory medicines. If the gout attack is mild, anti-inflammatory drugs available without a prescription may relieve pain. Because there are serious side effect of using non-steroidal anti-inflammatory drugs even the over-the-counter strength be sure to check with your doctor before taking them.
Prescription medications. Your doctor may recommend a prescription-strength non-steroidal anti-inflammatory medicine such as indomethacin.
Colchicine is also given to reduce inflammation during an acute gout attack. This drug has recently been approved by the Federal Drug Administration for treatment of gout. Like all medications, colchicine has side effects that you will need to discuss with your doctor.
Your doctor may also prescribe corticosteroids for acute gout attacks. These are strong anti-inflammatory medications that can be taken either in pill form, intravenously, or injected into the painful joint. Cortisone may improve the severe inflammation very quickly.
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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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