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
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.
S To Care For Yourself During A Gout Attack
There are some steps you can take at home to help ease the pain of gout, encourage kidney function, and lower the levels of uric acid thats triggering and worsening your flare-up:
- Increase your fluids, especially water
- Dont resist the urge to urinate
- Rest, elevate, and ice your painful joints
- Take an anti-inflammatory pain medication like ibuprofen or naproxen
- Use epsom salt soaks
- Take any prescribed medicines that decrease your uric acid levels
- Eat foods and supplements that lower uric acid, such as magnesium, sour cherries, ginger, and celery
- Stay away from alcohol, shellfish, and red meat, which cause your body to make uric acid
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Causes Of Gout Flares
Gout, a type of inflammatory arthritis, happens when levels of uric acid a normal byproduct of metabolic reactions in your body become too high, says Kenneth Saag, MD, professor of medicine in the division of clinical immunology and rheumatology at the University of Alabama at Birmingham. When this substance cant be sufficiently dissolved and excreted in the urine, it starts to crystallize, and those crystals deposit themselves in joints where they cause severe inflammation.
Certain risk factors, such as having a family history/genetic predisposition or having chronic kidney disease, can affect the development of gout over time. Taking certain medications , a high alcohol or sugar intake, or eating high-purine foods can trigger a gout flare. Read more about what causes gout here.
If youre new to gout, your doctor will need to confirm the diagnosis, as it can sometimes masquerade as other ailments that impact the joints . Your doctor will likely use a needle to remove some fluid from the swollen joint, then examine it under a microscope to confirm that it contains uric acid crystals.
Foot Gout Symptoms To Watch For
Foot gout usually occurs suddenly, often at night. In most cases, flare-ups happen without warning. The best way to catch foot gout in its early stages is by knowing the symptoms. Symptoms of gout include:
- Acute, intense pain within the joint
- Discomfort for days after the severe pain subsides
- Inflammation or swelling in the joint
- Sensation of heat within the joint
People who suffer from this condition on a regular basis typically know the symptoms of gout and know to seek treatment at the first sign of a flare-up. Sometimes the symptoms are severe enough to bring on a fever of up to 101°F.
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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.
Additional Tips For Treating Gout Naturally
Studies show that many of the dietary items we consume lead to gout as well as other health problems. Changing your diet and lifestyle may be the easy solution to beating gout. One of the first things to do is eliminate certain foods and beverages from your diet to beat gout.
1. Eliminate or reduce sugar intake
As many studies are now illustrating, gout is common in people with excessive sugar intake, especially high fructose corn syrup Its wise to read the labels of all your food and drinks. If you find HFCS then eliminate that from your diet. In addition, look for sugar added under the guise of other common names for sugar look for cose at the end of words and these are probably types of sugar you dont want to be consuming.
2. Eliminate grains
Grains in the body are converted to sugars so again you want to limit or avoid grains altogether. They are also very inflammatory to your body.
3. Limit alcohol consumption
Again, alcohol becomes sugar once ingested so eliminate this completely unless you have a healthy body already. Any substance that will be converted to one or another type of sugar by the body should be avoided at all costs. In order to get your uric acid levels down you must consistently avoid sugar in your diet.
4. Eliminate soda and diet soda
5. Consume cherries and strawberries daily
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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
Reduce The Pressure Reduce The Pain
Gout cant be cured, but it can be managed effectively and ensuring that your feet receive expert care plays an important part in that process.
Our London podiatrists can help to relieve the pain caused by gout in your big toe with prescription orthotics. These custom-made shoe inserts are designed to make the affected area more comfortable by reducing the pressure its under. Whats more, we can offer expert advice on which shoes youll find most comfortable.
Podiatric padding and foot shields can be beneficial when gout strikes. In addition, if the swelling has led to sores, ulcers, calluses, etc., we can treat those issues too.
For expert help to relieve the foot pain caused by gout, please call Feet By Pody today on 0207 099 6657 or book a podiatry appointment online.
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Take Care Of Your Feet If Suffering From Gout
Your feet have about 26 bones and a complex framework of muscles, ligaments and tendons. With every step you take, your feet absorb the full impact of your full body weight keeping you upright and balanced.
Did you know that the health of your feet can be indicative of your overall health? Having stiff joints can indicate arthritis, tingling or numbness could mean you have diabetes. Swollen feet can mean kidney disease or heart disease. It is very important to have healthy feet. Your feet are the foundation of your body after all.
Suffering from gout may cause all kinds of complications if one is not careful and one things for sure, you want to keep your feet healthy and strong. I bring this up cause a recent study indicates that gout sufferers aged 45 and older are more likely compared to those that dont have gout, to have lower but not upper extremity dysfunction. They are more likely to walk slower than average for their age.
The study also showed that those who suffer from hyperuricemia, had also poor performance in the lower extremities as in their feet. The way the researchers measured lower extremity function included repeated chair stands, standing and balancing, and a 4-meter walk test. This study should wake us up to the fact that we can suffer a similar fate, if we fail to keep our feet healthy and strong as much as we can.
What To Do After A Gout Flare
While its possible to have an isolated gout attack, normally once gout strikes youll need prolonged therapy to manage it, says Dr. Saag. If you dont take regular uric-acid lowering medication or find another way to get your uric acid levels down cutting back on alcohol, losing weight, and cutting back on high-purine foods may make a difference over time you will likely experience shorter intervals between gout flares, he explains. Gout ultimately becomes a chronic arthritis, and it can be quite disabling.
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Replies To Gout And Your Feet
- Pamela ParksFebruary 7, 2019
Im wondering Im just getting over gout and was thinking about a pedicure, the swelling gone, just still a little sore but not reddish purple anymy!! Is it ok to get a pedicure?
- Spiro KoulourisFebruary 9, 2019
It depends. If it still hurts, wait a little more, if not go ahead. Touch your feet and play around with them as if somebody would be giving you a pedicure and see.
Have had gout for years. Just recently went to dr. gave me allopurinal and colchicine 0.6 mg. Big toe is numb and cant bend at all, now right side of foot has pain. Any suggestions.
No other inputs Sam but to get it checked. I would check it with a qualified rheumatologist and take it from there. It can be either or but nobody can diagnose you until you get your uric acid results back. If you think its bunions go also and visit a podiatrist.
I have had gout on and off for years.The past few weeks the gout had gone to myknee then the foot and the other knee andfoot. Right now the gout seems to be gone.I have no pain but my foot and ankle is reallyswollen and hot to the touch. Is this common?
Yes it could be Paul. Especially if your gout is moving around in different places inside your foot. Go visit your doctor to make sure.
Best to see a podiatrist so he/she can examine your foot and maybe recommend a custom made sole just for your foot.
What To Do During An Attack
- 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.
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How Can I Treat My Foot Gout
Gout is easily treated. The main goal of treatment is to lower the uric acid levels in your body, decrease pain and other symptoms, and prevent further attacks or flare-ups.
If you only experience one episode of foot gout, your doctor may recommend a non-steroidal anti-inflammatory drug other than aspirin, such as ibuprofen or naproxen.
Aspirin is not used to treat gout because if can interfere with the excretion of uric acid crystals in your urine. Doctors have several ways to treat your gout, including:
- Anti-inflammatory medications or injections to reduce pain, swelling, and inflammation
- Corticosteroid injection into affected joint to reduce inflammation
- Suggesting a change in diet to eliminate or reduce intake of foods and beverages that are high in purines and protein because protein can increase your uric acid level
- Encouraging the patient to drink plenty of fluids each day, especially water
- Explaining the importance of avoiding alcoholic beverages
- Requiring you to stay off your feet
- Cold compresses
It is very important that you talk to a doctor if you are experiencing foot gout symptoms or a flare-up.
Symptoms will generally subside within three to ten days with treatment. If the problem is left untreated, or if gout continues to occur with treatment, the uric acid buildup can eventually cause arthritic damage to your joint.
In severe cases, your doctor may recommend surgically removing the uric acid crystals from your joint.
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
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
Treating Gout In Your Foot
Gout is usually treated with medication. Medication could either be used to manage pain and inflammation or to lower the uric acid levels in your blood to prevent future gout attacks.
Medications for managing pain include nonsteroidal anti-inflammatory drugs , corticosteroids, and colchicine. NSAIDs can help to reduce inflammation and pain in your affected joints and the surrounding tissues. High doses of short-acting NSAIDs tend to give you the quickest relief.
Corticosteroids are an option for persons who cannot take NSAIDs. You can take corticosteroids orally, or your doctor can inject it directly into the muscle or affected joint.
Colchicine can decrease the swelling and lessen the build-up of uric acid crystals in your joints.
There are also medications that you can use to help prevent gout and gouty flare-ups. Medications called xanthine oxidase inhibitors could be used to decrease uric acid levels in your blood. Other medications like probenecid can help your kidneys to remove uric acid from your body.
Managing Pain with Medication and Other Techniques
How You Can Manage And Prevent Foot Gout
Regardless of whether you have ever suffered from gout, you should know that managing the condition is not as simple as taking medication during a flare-up. You should talk with your healthcare provider about your lifestyle, diet, and overall health.
You may need to make changes in your lifestyle to prevent recurrence. You should always keep personal records of gout attacks to discuss with your doctor.
Exercising, eating healthy, maintaining an average weight, and avoiding things that increase your uric acid levels are all essential to preventing and managing gout.
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How Is Gout Treated
When you have a gout attack, pain relief is your first goal. Its important to call your doctor even if the pain has stopped. The uric acid buildup that triggered your gout attack may still be irritating your joints and could eventually cause seriousdamage, like joint destruction and kidney damage.
Your doctor may:
- Give you a shot of corticosteroids to ease discomfort quickly
- Prescribe a long-term medication that can prevent and even reverse uric acid buildup
- Recommend lifestyle changes or alternative treatments
Theres a lot you can do on your own to ease symptoms:
- Rest the affected joint until the attack passes and for 24 hours after the attack.
- Elevate painful joints.
- Use ice to reduce swelling.
- Relieve inflammation with NSAIDS . Avoid aspirin, which can worsen symptoms.
- Limit alcohol, especially beer and hard liquor.
- Cut back on meat and seafood, which can raise uric acid levels.
- Follow a moderate exercise program.
- Control your weight. Being overweight increases your risk for gout.