Gout & Your Feet
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 (preens) 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 foot and ankle 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.
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 foot
and ankle surgeon also will reduce the potential for an attack.
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