Gout and Your Feet

Definition and Causes

Gout is a type of arthritis that is caused by the accumulation of uric acid in the body and the joint fluid (hyperuricemia).  The build-up of uric acid commonly happens when the body does not process well certain proteins, which occur naturally in our diets, called purines (PURE-EENS).

The actual accumulation of uric acid results when the body does not eliminate uric acid through the kidneys and urine, or when the body produces too much uric acid.  It is a hereditary tendency to accumulate uric acid.  This hereditary tendency may skip an individual or a generation and reappear in the children of someone without any signs of gout.  Gout is most prevalent in males between the ages of 50 and 60, although there are occurrences in females and in younger males.

Symptoms

The onset of gout is signalled by a sudden onset of pain in one or more joints, commonly in the joint of the big toe of the foot.  Redness, swelling, and warmth over the joint accompany the pain.  Often the patient does not remember injuring the joint before the pain begins.  Many patients report that they first notice the pain in the middle of the night or upon rising in the morning.

The symptoms occur most often in the big toe joint; however any joint may be affected.  Other typical areas of pain are the instep of the foot, the ankle, or the knee.  When the foot is affected, it is difficult and painful to wear shoes and to move the joint or stand on the foot.

Gout usually starts with a sudden onset of intense pain in one or more joints, usually the big toe joint of the foot.  The pain is accompanied by redness, swelling and warmth over the joint.  Typically, the patient does not recall injuring the joint before the pain started.  Many patients say they first noticed pain in the middle of the night or upon arising in the morning.

Diagnosis

Diagnosis of gout is based on personal and family history along with and examination by the doctor that often finds the common symptoms of gout and makes a clear diagnosis.  Uric acid levels are often determined by performing blood tests, and uric acid crystals can be found by examining joint fluid.  Both bones and joints are examined through x-rays to rule our abnormal changes due to gout.

Treatment

The first step for treating gout is obtaining a correct diagnosis.  An acute attack of gout is most often managed through oral anti-inflammatory medications.  Over-the-counter medications may reduce symptoms of gout; however they are rarely effective in treating the acute pain, swelling, and inflammation.  When the symptoms of gout occur in the toe, relief is often found by elevating the foot, avoiding standing and walking, and wearing loose slippers until consulting a podiatric physician.

Controlling gout is commonly achieved with prescribed medication, when there is an acute symptom and for on-going treatment.  It is important that your doctor to determine whether producing too much uric acid or not eliminating it properly is responsible in order to determine the effective medication to treat the gout.

If the symptoms of gout continue despite medical treatment, if deposits of uric acid crystals in a joint are excessive, or if arthritic pain is continual, surgery may be required to treat the gout by removing the crystals (tophi) and repairing the joint.  By not considering surgery when necessary may cause permanent arthritis of the joint(s).

Prevention

Foods high in purines can elevate uric acid levels and cause an acute attack of gout.  Such foods include red meats, shellfish, beer, red wine, and salt.  Certain medications such as diuretics (water pills), often prescribed to control high blood pressure or reduce swelling, may be responsible for acute attacks of gout.  Gout may also be caused by stress, infection, and trauma.

The chance of an attack of gout can be reduced or the severity of an attack can be lessened by consuming 6-8 glasses of water daily, eating an appropriate diet, and evaluating current medications.  Regular visits to a podiatric physician will also reduce the chances of an attack if you have a personal of family history of gout.