Gout is condition that can cause sudden, intense pain in the joints and surrounding tissues of your foot or ankle. It most commonly affects the big toe but can occur in any joint of your foot or ankle. It can also occur in other joints of your body.
Gout occurs when there is too much uric acid in your blood. Uric acid is a common byproduct of the breakdown of purines, which are naturally occurring substances found in meats, seafood, alcoholic beverages, sugary products, and beans as well as wheat products. Your body also produces purines.
There are multiple causes for developing gout including:
Patients with gout can have a sudden onset of swelling, pain, and redness involving the affected joint and surrounding area. It can look similar to an infection.
You may have difficulty walking or wearing shoes. Sometimes even having sheets rub your foot can be painful. If you notice any of these symptoms, it is important to make an appointment with your foot and ankle orthopaedic surgeon.
Over time, patients can develop swelling or thickening of joints. This is due to longstanding deposits of uric acid called "tophi" building up in the body.
A patient with tophi deposits in the big toe joints on both feet due to longstanding gout.
Your surgeon can often make a diagnosis of gout based upon a thorough history and physical exam. Frequently, recent consumption of foods such as shellfish, meats, cheeses, or alcohol accompanies the sudden onset of pain and swelling in a joint. There may also be a family history of gout. Your surgeon may request a blood test to look for elevated levels of uric acid.
If possible, the best method to diagnose gout is to obtain fluid from the swollen joint. The fluid is straw-colored and can have a cloudy appearance to it.
Treatment is aimed at both treating the current episode and preventing future attacks. For mild symptoms, avoiding the offending foods/beverages (if this is the cause) as well as medication can help. Nonsteroidal medications, called NSAIDs (Nonsteroidal Anti-inflammatory Drugs), as well as colchicine are given for treatment. As with any medication, it is important that you consult with a physician prior to starting the medication. During a mild attack, you can reduce swelling by icing and elevating the affected foot.
In certain cases, cortisone can be injected directly into the joint to reduce the swelling and pain.
For patients who have high levels of uric acid in the blood, medication can be given on a long-term basis to help reduce levels to a normal level. In longstanding cases where tophi are present, surgery may be necessary to remove the material.
Modifying your diet and lifestyle can help reduce the risk of attacks. Avoid foods that are high in purines, such as red meat, shellfish, cheese, and sugary foods. Medication can also reduce the risk in certain cases; talk to your doctor before starting any medication.
The symptoms of an acute gout attack (redness, swelling, pain, stiffness) can be similar to an infection. Your foot and ankle orthopaedic surgeon can help determine the difference. It is important to see your surgeon as soon as possible if you have any of these symptoms.
Original article by Sudheer Reddy, MD
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