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Foot Gout



Gouty foot is a fairly common problem that  is characterized mainly by acute intense pain, that usually occurs at night and without warning unfortunately.

The standard classic signs and symptoms:

  • very localized pain in the foot
  • swelling
  • increased temperature
  • heat
  • redness
  • tenderness to touch and pressure

And most of the time, it happens in the big toe (medically termed as "podagra") but of course can affect other parts of the foot, ankle and toes. Though gout usually affects/attacks the foot, yet in some patients, it can happen in the knee as well.

Patients who suffer from gout/gouty arthritis usually have recurrent gout attacks.

The symptoms usually

  • attacks/come very quickly
  • usually at evening or night time
  • tends to be the most intense, acute and painful in the first 12-24 hours of the gouty attack

first of all, What Is Gout?

Gout refers to the common type of inflammatory arthritis that is caused by the accumulative build-up of uric acid crystals, which then later travel through the blood stream and lodges/"attacks" a joint (typically the big toe or foot).

Uric acid is a natural byproduct that is created when our bodies process/breakdown food such as meat and seafood that contains higher purine concentration.

In healthy population, uric acid is filtered out and removed through our kidneys without any issues.

But in some populations, their kidneys are unable to remove the uric acid quickly enough and over time, the uric acid forms into uric crystals (tiny crystals that are spiked and sharp). Normally there is no symptoms, but as more crystals accumulate (can take years and years), and as the volume of these sharp spiky crystals go up, they cause problems.

Especially if any of these crystals enter joint space/soft tissue - they will irritate and damage the joint and its surroundings, causing very intense acute pain, swelling and tenderness.

Foot gout most commonly occurs at the base of the big toe, known as the metatarsophalangeal joint. 

Symptoms of Foot Gout

The most common symptoms of foot and ankle gout are

  • intense, sharp and acute pain
  • swelling
  • redness
  • heat and increased temperature
  • tenderness over the affected joint. 

Foot gout acute pains and symptoms usually occur very suddenly and increase in pain over just a few hours, usually at night. The reason why it's theorized to happen moreso at night includes:

  • lower temperature at night
  • long day of moving around/mobilizing

In very bad cases, foot gout symptoms may also come with fever and fatigue.

Each got episode can last between five to ten days, and unfortunately, more than 60% of gout patients will get a recurring attack within a year...and usually over time, the frequency of the foot gout attacks will increase and more joints will be affected over time.

Got tends to affects moreso the extremities and big toe, but patients can also suffer from:

  • gout in the ankle or
  • gout in the knee

In some cases, it may also affect fingers, wrists and elbows.

foot gout Risk Factors

Whilst gout foot flare ups often happen (and sometimes can happen for no particular reason), there are a number of factors that have been linked to an increased risk of the disease:

  1. Medical Conditions such as diabetes melitus, kidney diseases, high blood pressure, osteoarthritis and high cholesterol increases the risk of developing the disease

  2. Diet: regular comsuming foods with high purine levels such as seafood, red meat and offal, as well as alcohol (especially beer and spirits) and sugary drinks have been shown to increase the risk of foot gout

  3. Genetics: 20% of cases is related to genetics

  4. Obesity: people with a BMI greater than 35 are 300%s more likely to develop the condition

  5. Medication: some medications will cause an internal increase of uric acid levels and therefore the risk of developing foot gout. These include diuretics (water tablets), beta blockers, aspirin (when taken regularly) and niacin (for high cholesterol)

  6. Gender: Men tend to suffer from the condition at a younger age than women due to higher levels of uric acid. For women, after menopause, their uric acid level rise which increases the risk of the condition and only 15% of female sufferers are pre-menopausal.  Over the age of 60, the risk of developing the disease is equal between the two genders but over the age of 80, it is more prevalent in females.

Foot Gout Diagnosis

To diagnose foot gout accurately, the treating physician needs to dive deep to understand and ask questions about your symptoms eg:

  • when did the symptoms start
  • what and when were the previous episodes
  • current diet (food and beverage) habits
  • family history of gout or not

From this, then the doctor usually will run more tests to ensure accurate gout diagnosis, which includes:

  1. X-rays: your doctor may send you for an x-ray usually to either rule out other causes (eg osteoarthritis/fractures/dislocations etc) or to look for signs of chronic gout where the bone becomes affected

  2. Joint Fluid Analysis: Your doctor may take a small sample of swelling fluid from the affected joint using a syringe (this is called "aspiration"), and it will then be analysed for the presence of uric acid crystals, which gives a definitive/clear foot gout diagnosis

  3. Blood Tests: are used to look for high levels of uric acid in the blood, known as hyperuricemia. 

    These blood tests are most reliable 4-6 weeks after the initial gout foot attack. However, note that these blood tests can be unreliable – 50% of sufferers may never show high uric acid levels whereas people who don’t suffer from the disease sometimes do have high levels

  4. Ultrasound Scans: These are become more popular as they are a good, non-invasive way of looking for the presence of urate crystals in the joint

foot gout Treatment Options

Foot gout treatment starts by addressing the pain associated with the flare up.  Once the symptoms have subsided, further treatment concentrates on lowering uric acid levels to prevent further attacks.

  1. Medication: Non-steroidal anti-inflammatory medication (NSAIDs) such as ibuprofen and naproxen help to relieve pain and inflammation associated with foot gout

  2. Water: drink lots of water to flush out the swelling/uric acid

  3. Corticosteroids: If you can’t tolerate NSAIDs or colchicine, your doctor may recommend a short course of oral steroids, or a steroid injection into the affected joint to help relieve pain and inflammation.  Long term, high dose use is however not recommended due to side effects.

  4. Supplements: Many gout sufferers find great relief using supplements to reduce uric acid levels.

    There are a number of different types available that can help to reduce both the frequency and intensity of flare ups. You should always check with your doctor before taking any supplements. Find out more about gout supplements

  5. Cold Therapy: can help reduce the pain and inflammation associated with flare ups.

foot gout Prevention Strategies

Foot gout prevention aims to reduce the number of flare-ups people experience by reducing the levels of uric acid.  This can be done with medications as well as healthy lifestyle changes.

  1. Medication: medication to reduce uric acid levels helps prevent the formation of uric crystals plus dissolve any existing crystals. 

    Common prevention medications include allopurinol and febuxostat.  These usually need to be taken daily and it can take a while to find the correct dosage for you

  2. Diet: decreasing and even avoiding food and drinks that are high in purine is a great gout prevention tactic.  Avoiding game meat, offal (e.g. liver and kidney), oily fish and seafood

  3. Drink Plenty Of Water: keeping well hydrated reduces uric acid crystal formation in the kidneys.  Aim to drink approximately 1.5 litres per day, more if you perspire often/lots

  4. Lose Excess Weight: studies show that people who score more than 35 on the BMI are 300% more likely to develop gout (and painful foot gout). Hence aiming to lose the extra weight should be one of the focus.

  5. Vitamin C taking a daily dose of vitamin C has been shown to reduce the risk of the disease by about 45% - but it's always good consult your doctor before taking any supplements

  6. Limit Alcohol Intake particularly beer/spirits which contains high levels of purine

  7. Exercise: Regular exercise helps to reduce the risk, keeps you active and healthy

  8. Avoid Fructose-sweetened food and drink as they increase the risk of gout

Our senior physiotherapists are able to help you with customizing a specific exercise and training program (including personal training and pilates) for:

  • strength, stamina and stability training
  • weight loss
  • fitness

References



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