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:
Points To Remember About Gout
- Gout is a type of arthritis that causes pain and swelling in your joints, usually as flares that last for a week or two, and then go away.
- With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis.
- The most common symptom of gout is pain in the affected joint, such as the big toe.
- Your doctor may recommend taking medications to manage the cause of your gout and treat active gout flares, and making changes to your diet and lifestyle.
What Is Gout In Ankles And Symptoms
It is a condition developed when the crystals of uric acid are formed in the joint. Besides, this disease has an unpredictable nature, i.e. you would not experience the symptoms for a long time, then suddenly you will be struck by a gout attack. There are cases where gout begins in the toes and gradually moves up to other joints like the ankle.
Listed below are the common gout symptoms ankle:
- Severe pain
- Limited range of motion of the ankle
- Warm to touch
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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
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:
- tenderness
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S To Take During A Gout Flare
A gout attack is one of the most painful experiences you can have. It usually doesnt give you much warning, and comes on suddenly. According to the National Kidney Foundation, gout is on the rise and affects more than 8 million American adults.
In each of our locations in Michigan, our team at Great Lakes Foot and Ankle Institute welcomes patients who are suffering from this extremely agonizing form of arthritis. Our team of knowledgeable podiatrists offer some advice for ways you can manage your gout pain during a flare-up. But first, lets cover some general information about gout.
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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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.
How Uric Acid Crystals Form
Infographic
The build-up of uric acid crystals begins with purines, a chemical compound found in many foods.
- When the body metabolizes purines, it produces a substance called uric acid.
- The uric acid enters the bloodstream.
- The kidneys filter the blood and normally filter out excess uric acid. This uric acid is then excreted via urine or stool .10
- If the kidneys cannot adequately filter out excess uric acid, or if the body produces too much uric acid, there will be too much uric acid in the bloodstream.
- Too much uric acid in the bloodstream is called hyperuricemia.
- In some people, hyperuricemia leads to the formation of uric acid crystals that collect in joint tissue, leading to painful symptoms.
An inability to adequately process and excrete uric acid accounts for an estimated 90% of gout cases.9 Other cases occur because a body produces too much uric acid.
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Conservative Treatment For Gout Includes:
In order to prevent recurrent gouty attacks, oral medications such as Allopurinol, Colchicine, Uloric, and Probenecid can be used. The medication used to prevent gouty attacks is determined by whether or not the patient is overproducing or under excreting uric acid.
One of the mainstays of preventing recurrent gouty attacks is to follow a gout friendly diet. This includes limiting or avoiding beer, shellfish, and certain meats. Patients are instructed to learn about all of the foods that can cause gout and are instructed to avoid these foods.
Signs And Symptoms Of Gout In Ankle
The initial signs and symptoms of gout in the ankle joint are redness, hard swelling, discomfort, and tenderness.
This may sometimes lead to disability or a limited range of motion if not cared for initially.
In many cases, sudden intense pain of gouty feet feels like your foot is on the fire. Sometimes these symptoms are also accompanied by fever and chills.
How long does a gout attack last?
On average, a gout attack may last from 3 days to a week.
However, in a few cases where the problem is severe/stubborn, it may take from 10 days to a few weeks to get the recovery .
It has been seen that there are people who experienced only a single attack of gout in their lifetime.
They actually controlled and avoided future attacks by making certain dietary changes and following natural remedies.
It is important to seek proper medical care as soon as you feel infectious gout in your foot or ankle.
Failing can cause conditions to worse out including severe foot pain and joint damage.
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What Does A Gout Attack Look And Feel Like What Would A Foot Or Toe With Gout Look Like
When gout occurs, the joint tends to be extremely painful and is warm, red and swollen . The inflammation that is part of a gout attack is systemic, so that fever and chills, fatigue and malaise are not uncommonly part of the picture of a gout attack.
Figure 6: Toe with Acute Attack of Gout
Gout attacks can occur in joints that look normal, or in joints that have easily visible deposits of uric acid. These deposits are called tophi and can be in numerous locations, but especially on the feet and elbows. In Figure 9, the little finger of the right hand is bandaged since fluid was just removed from it, which demonstrated innumerable uric acid crystals.
Figure 7a: Tophi on Foot
Figure 7b: Tophus Over Achilles’ Tendon
Figure 8: Tophus on Elbow
Figure 9: Tophi on Hands
Figure 10: Large Tophus of Finger
While some gout attacks will solve quickly by themselves, the majority will go on for a week, several weeks, or even longer if not treated. Since gout attacks are usually quite painful and often make walking difficult, most gout sufferers will request specific treatment for their painful condition.
What Are The Symptoms Of Gout
An episode of gout is called a gout attack. Gout attacks are very painful and can happen quite suddenly, often overnight. During a gout attack, symptoms in the affected joint may include:
- Intense pain.
- Tenderness, even to light touch, such as from a bedsheet.
- Warmth, or a feeling like the joint is on fire.
- How long does a gout attack last?
A gout attack can last a week or two. Between gout attacks, you may have no symptoms at all.
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Surgical Treatment For Gout Includes:
When patients have repetitive gouty attacks in a joint, the joints can become destroyed. This can lead to severe pain and disability. In cases where the symptoms are not relieved by conservative case, Dr. Stewart generally recommends surgery to fuse the joints affected by gout. Once the joint is fused, gout will no longer occur as the joint space has been eliminated.
What Causes Ankle Gout
Gout occurs due to the accumulation of urate crystals in the joint, causing inflammation and intense pain. These crystals can form when you have high uric acid in the blood . Your body innately produces uric acid when it breaks down purines-substances that are found naturally in the body, as well as in certain foods, such as steak, organ meats, and seafood. Other foods that promote higher levels of uric acid include alcoholic beverages and drinks sweetened with fructose .
In a normal individual without gout, uric acid dissolves in the blood and passes through the kidneys to be expelled in the urine. But sometimes, the body produces too much uric acid, or the kidneys excrete too little of it. When this happens, uric acid can build up, forming sharp, needle-like urate crystals that become deposited in a joint or surrounding tissue causing pain, inflammation, and swelling.
Uric acid crystals tend to form in cooler temperatures, which is why they tend to form in the distal extremities, such as the hands and feet, which have a higher likelihood of becoming colder than the rest of the body.
Possible medical and health triggers of gout include:
- Infection
- Intense pain
- Possible fever
Symptoms tend to recur anywhere from six months to two years after the initial episode, with approximately 60 percent of gout patients having a recurrence within one year.
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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.
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.
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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.
Help From Your Podiatrist During A Gout Attack
If your gout flare-up is so painful that youre having trouble being productive, please come see us at one of our convenient locations. We understand how painful gout is and work with you to provide immediate relief, while also taking measures to prevent future flare-ups. Some of the treatment options we offer include:
- Corticosteroids injections or pills
- Anti-inflammatory medications
- Nutrition counseling
In severe cases when medication doesnt help your symptoms, you may need a surgical procedure to eliminate uric acid crystals that accumulate in your affected joint.
Partner with us to prevent gout or treat a flare-up. in Chesterfield, Clinton Township, Fort Gratiot, East China Township, Shelby Township, or Rochester, Michigan or .
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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.