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.
How To Recognize Gout
The symptoms of your first gout attack will likely alert you that something is wrong. However, the symptoms can be so severe that you may attribute them to another medical condition, which could delay you in getting an accurate diagnosis.
Typical symptoms of gout include:
- Symptoms that develop suddenly and without warning, escalating to extreme intensity in just a few hours
- Pain so extreme at the affected joint that its often impossible to put weight on the area
- Symptoms so intense that they may awaken you from a sound sleep
- Swelling and/or redness at the site of the affected joint
- Fever and fatigue
Why Does Gout Target The First Metatarsophalangeal Joint
The studies discussed above provide clear evidence of an association between MSU crystal deposition and OA. Whilst further studies are required to definitively answer the questions of direction of association and causality, it appears that MSU crystals more readily deposit in osteoarthritic cartilage and that the presence of OA influences the distribution of joints affected by gout. However, OA cannot solely explain the typical distribution of joints affected by gout, as many joints commonly affected by OA such as the knees, finger IP joints, and hips are less frequently affected by gout than the first MTPJ, and other target joints for gout such as the ankle, wrist and elbow are infrequent sites for primary OA. Is it plausible therefore that the relationship between MSU crystal deposition and OA is of more relevance for the first MTPJ than other joint sites?
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How Is Gout In The Ankle Diagnosed
If you think you might have gout but havent been diagnosed, try to see a doctor while youre having symptoms. Gout is easier to diagnose when youre in the middle of a flare-up thats causing swelling, redness, and other visible symptoms.
During your appointment, your doctor will likely ask you several questions about your diet, any medications you take, and whether you have a family history of gout. This can help to rule out other potential causes of your symptoms, including an infection or rheumatoid arthritis.
Your doctor may also order a blood test to check your uric acid levels. But some people have high levels of uric acid and dont develop gout. Others have typical uric acid levels but still develop gout. As a result, theyll want to do some other tests as well.
An X-ray, MRI, or CT scan of your ankle can also help to eliminate other possible causes of joint inflammation. Depending on your exam, they may also order an ultrasound to check for the presence of crystals in your ankle.
Finally, they might do a joint fluid test. This involves taking a small sample of joint fluid from your ankle with a small needle and looking at it under a microscope for any uric acid crystals.
Based on the results of your exam and tests, they may refer you to an inflammatory arthritis specialist called a rheumatologist for treatment.
Theres no cure for gout, but a combination of medications and home treatments can help to manage ankle pain and reduce the number of flare-ups you have.
What Could Be My Problem
Gout is a form of arthritis caused by a buildup of uric acid crystals in the joints. Acute gout attacks are characterized by a rapid onset of pain in the affected joint followed by warmth, swelling, reddish discoloration and marked tenderness.
The small joint at the base of the big toe is the most common site for an attack. These painful attacks usually subside in hours to days with or without medication. In rare instances, an attack can last for weeks.
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How Does Gout Affect The Feet
There are more than 100 different types of arthritis, but they all boil down to one thing joint pain and inflammation. In this regard, gout is no different, but its unique in that it can cause stabbing pain in your feet and ankles during a flare-up.
The team of highly qualified musculoskeletal experts here at Western Orthopaedics has you covered from head to toe and toe is an appropriate usage here as gout most often strikes your big toe.
Heres a closer look at gout, how it affects your feet and ankles, and what we can do to manage the problem.
When To See A Doctor For Gout
If you think youve had a gout attack and never experienced it before, see a doctor. They should be able to make a diagnosis and rule out other possible causes for your symptoms.
If you have gout, a doctor may prescribe medications to help relieve swelling and inflammation, such as non-steroidal anti-inflammatory drugs , steroids or colchicine. These can be used to help ease symptoms during an attack of gout, but you should get further guidance from a doctor before taking any of these medications.
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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.
Symptoms Of Foot Gout
A gout flare in the foot can be sudden and extremely painful. It feels like your big toe is on fire as it feels hot, swollen, and tender. The first 36 hours are the worst but after that, the pain lessens and lingers, but it doesnt entirely go away until after a week or two.
Once you experience a gout attack, call your doctor right away. They will provide you with medication to help lower uric acid levels and prevent it from worsening.
You may have difficulty walking or wearing shoes when you have foot gout. Its pretty common for gout sufferers to walk slower, have reduced stride length, and less pressure on the midfoot. This is because gout in the foot can be very painful and walking in such a manner can help lessen the pain.
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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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Medications For Gout Attacks
To treat gout attacks and to prevent future ones, you doctor may recommend these medications:
Nonsteroidal anti-inflammatory drugs
Initially, your doctor might suggest over-the-counter NSAIDs, such as naproxen sodium or ibuprofen .
If these OTC medications arent enough, your doctor might prescribe more powerful NSAIDs such as celecoxib or indomethacin .
Colchicine is a medication that your doctor may prescribe based on its proven effectiveness in reducing heel gout pain.
Side effects of taking colchicine, especially in large doses, can include diarrhea, nausea, and vomiting.
If NSAIDs or colchicine arent appropriate for you, your doctor might recommend corticosteroid medications, either in pill form or via injection, to control inflammation and pain.
An example of this type of medication is prednisone.
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Gout And Your Kidneys
An overabundance of uric acid can lead to both kidney problems and gout. Uric acid that collects in the kidneys can form kidney stones, which can lead to complications like kidney disease and kidney failure, and also can indicate a likelihood of developing gout. If youve been diagnosed with gout, your uric acid levels are elevated and you should also be checked for kidney disease.
Why Gout Often Attacks The Feet
While gout can impact any joint, it most often affects joints in the feet. About 75% of patients experience their first gout attack in the joint at the base of their big toe. Ultimately, more than 90% of people with gout experience a flareup at this location, though the condition can also affect the ankles, knees, wrists, fingers, and elbows.
The joint at the base of the big toe may be more susceptible to gout because uric acid reacts to changes in temperature. When exposed to lower temperatures, uric acid transforms into crystals. Since the big toe is a limb that is the farthest from the heart, it also has the lowest temperatures, which can make it a welcoming environment for gout.
The tendency for gout to occur at night may happen for the same reason. Your body temperature tends to be about 1-2 degrees lower when youre sleeping than when youre awake. In addition, some of the water in your joints synovial fluid is reabsorbed by your body when you sleep. However, the level of uric acid in your joints remains constant, leaving a higher concentration of uric acid and an environment welcoming to the formation of uric acid crystals.
You can set off an attack of gout by injuring the affected joint. Other events, such as surgery or treatments that change your body chemistry, can also trigger gout. Even stubbing your toe can trigger a gout attack if the area has enough uric acid crystals in place.
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Gout Attack Vs Chronic Gout
It is possible to have a gout flare-up and never experience another. Repeated instances of acute gout are called chronic gout17.
The treatment goals for a gout attack are different than those for chronic gout. When treating a gout attack, the goal is to relieve pain and inflammation. When treating chronic gout, the goal is to prevent future gout attacks and long-term joint damage.
While some people with chronic gout may get frequent gout attacks, others may have years in between attacks. If chronic gout is not treated, attacks may become more frequent and/or last longer.
Left untreated, a gout attack will usually resolve itself within a few days or weeks. Chronic gout can permanently damage a joints tissues and decrease its range of motion. For this reason, it is important to recognize symptoms, understand risk factors, get an accurate diagnosis, and treat and prevent gout.
Choose The Right Footwear
Because gout often affects the big toe, midfoot, and ankle, choosing good footwear is important. Dr. Iversen says a physical therapist can help evaluate the best footwear for a patient with gout based on evidence that shows specialized footwear provides benefits for patients by changing the alignment of the leg and foot, influencing the activity of the muscles of the foot, and your gait pattern . These modifications are designed to decrease the pressure on your joints.
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How Are Gout Attacks Prevented
Maintaining adequate fluid intake helps prevent acute gout attacks and decreases the risk of kidney stone formation in people with gout. Alcohol is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism and cause hyperuricemia. It causes gout by slowing down the excretion of uric acid from the kidneys as well as by causing dehydration, which precipitates the crystals in the joints.
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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Does The Location Of The Gout Attack Affect Treatment
No matter the location of gout attacks, the treatment is the samelower uric acid levels so gout crystals disappear and tophi dissolve. Your doctor can test your urine and blood to determine your current levels. Normal uric acid levels typically range between 3.5 and 7.2 mg in men and between 2.6 and 6.0 mg in premenopausal women.
How To Prevent Complications And Future Flares
Uric acid levels can be lowered in a number of ways. Your doctor may prescribe medication that reduces the intensity and duration of a gout attack and also breaks down the buildup of uric acid crystals. There are supplements that lower uric acid levels. And, these lifestyle changes also can help keep uric acid in check: avoid alcoholic beverages, stick to a healthy diet that limits foods high in purines, keep hydrated, and maintain a healthy weight.
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How Can I Manage My Gout And Improve My Quality Of Life
Gout affects many aspects of daily living, including work and leisure activities. Fortunately, there are many low-cost self-management strategies that are proven to improve the quality of life of people with gout.
For gout in particular:
- Eat a healthy diet. Avoid foods that may trigger a gout flare, including foods high in purines , and limit alcohol intake .
CDCs Arthritis Program recommends five self-management strategies for managing arthritis and its symptoms. These can help with gout as well.
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.
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Treatment For Gout In The Heel
There is no cure for gout, but treatment to limit attacks and control painful symptoms are available.
If your doctor diagnoses gout, they will most likely suggest medication and certain lifestyle changes based on findings in the testing and your current health.
Certain medications treat gout attacks or flare-ups. Others reduce the risk of potential gout complications.
The Pain And Swelling Of Gout Can Be Easily Treated
October 17, 2012 | Blog
Gout is actually a form of arthritis that commonly affects the big toe in men. It may cause a sudden burning pain in one of your joints, or stiffness and swelling in one or more joints. Attacks of gout can happen repeatedly unless it is treated. Eventually, gout attacks can cause long-term damage to your tendons, joints, and soft tissues.
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