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Gout and
Your Feet
- American
College of Foot and Ankle Surgeons©
Gout is a form of
arthritis that occurs as a result of the build-up of uric acid in the body and
the joint fluid (hyperuricemia). This accumulation of uric acid typically occurs
when the body has difficulty processing certain protein substances called
purines (PURE-EENS) that are found naturally in our diets.
The actual build-up of
uric acid can result when the body has difficulty eliminating uric acid through
the kidneys and urine, or in some cases, when the body produces too much uric
acid. The tendency to accumulate uric acid is often hereditary. It can, however,
skip an individual or even a generation and reappear in the children of someone
who has no signs of gout. While it is most commonly seen in males between fifty
and sixty years of age, gout does occur in females and in younger males.
Symptoms
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. While symptoms
most commonly occur in the big toe joint, any joint may be involved. Other
common sites are the instep of the foot, the ankle, or the knee. When the foot
is involved, wearing shoes is difficult and painful, as are attempts to move the
joint or stand on the foot.
Diagnosis
The diagnosis is based on a personal and family history, as well as on the
doctor's examination which often finds the classic signs of gout and makes the
diagnosis clear. Blood tests often are performed to determine uric acid levels,
and the joint fluid is examined to look for uric acid crystals. X-rays also may
be performed to examine both the bones and joints to rule out abnormal changes
associated with gout.
Treatment
The treatment of gout starts with establishing the correct diagnosis. Oral
anti-inflammatory medications are most often used to manage the acute attack.
While over the counter drugs may reduce symptoms, they are rarely strong enough
to treat the acute pain, swelling and inflammation. If the gout attack is in the
toe, it will typically help to elevate the foot, avoid standing and walking, and
wear only a loose slipper until the individual can be seen by a podiatric
surgeon. Gout often can be controlled with proper medication, both when there is
an attack and on a long-term basis. It is important that your doctor establish
which of the two primary causes (producing too much uric acid or not eliminating
it properly) is involved in order to treat the gout with the appropriate
medication.
If gout attacks continue
despite medical treatment, if there are excessive deposits of gouty crystals
within a joint, or if arthritis causes continual discomfort, surgical treatment
may be necessary to remove the crystals (tophi) and repair the joint. Failure to
consider surgery when it is needed may result in permanent
Prevention
Certain foods that are high in purines can increase uric acid levels and thus
bring on an acute attack of gout. These foods include red meats, shellfish,
beer, red wine and salt. Some medications, such as diuretics (water pills) that
are often used to control high blood pressure or reduce swelling, also may cause
an acute attack of gout. Stress, infection, and trauma also are possible causes.
Drinking 6-8 glasses of water each day, eating an appropriate diet, and
evaluating current medications will reduce the likelihood of an attack or lessen
the severity should it occur. If you have a personal or family history of gout,
regular examinations by a podiatric surgeon also will reduce the potential for
an attack.
© 1998 The American College of Foot and Ankle Surgeons
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