What is gout?
Gout is an extremely painful type of arthritis (joint inflammation). The disease can affect many joints but is most common in the big toe and knees.
People with gout have too much uric acid in their body. Uric acid builds up from a diet high in red meat or alcohol, or having a medical issue like diabetes or obesity.
High levels of uric acid cause sharp crystals to form. These tiny crystals collect in your joints. When they build up, they cause pain, swelling, warmth, and redness. Flare-ups that can last for weeks, and then it can go into remission for months or years.
In serious cases, gout might cause larger collections of crystals called tophi, which feel like hard lumps under the skin. Multiple gout attacks over the years can erode the cartilage and bone in your joint.
Most common symptoms
Dr. Rx
As you drift off to sleep, there is a sudden searing pain in your big toe. Even the light touch of bed sheets is intolerable. The toe joint rapidly becomes swollen, warm, red, and painful. Were you bitten by an insect? Did your shoes somehow give you an infection? In the morning, you call your doctor—now barely able to put pressure on your throbbing foot. You have podagra, or a gout attack of the big toe. —Dr. Benjamin Schwartz
The most common symptoms are severe pain, swelling, redness, and warmth in your joints. Symptoms come on suddenly. The joint might be very sensitive, even to the lightest touch.
At the start of a gout attack, the pain and swelling will make it hard to move the joint. (You may mistake it for an infection.) Your range of motion will be limited.
Usually, gout happens in the joint at the base of the big toe. (Also called podagra.) But it could also happen to your knees, ankles, elbows, wrists, or fingers. The more intense pain might last 4 to 12 hours, but you may feel pain or discomfort for days to weeks.
Main symptoms
- Sudden pain, stiffness, swelling, and redness in one or more joints (often the big toe)
- Sensitivity to touch
- Limited range of motion in that area
Other symptoms you may have
- Hard lumps (tophi) under the skin surrounding the joint
- Kidney problems (stones, kidney failure)
- Joint destruction (if you have repeated gout attacks every year for several years)
What is the main cause of gout?
When uric acid builds up, it causes gout. It is normal to have some uric acid in your blood, but people with gout create too much of it. Or their kidneys can’t get rid of it very well.
Certain foods (red meat, organ meat, seafood, alcohol) are high in a natural chemical called purine, which is broken down into uric acid in your body. Ditto with fructose, the sugar in sweetened drinks.
When uric acid levels get too high, sharp, needle-like crystals form. They get into the joint or surrounding tissue. This causes inflammation, pain, redness, and swelling.
Pro Tip
Because the symptoms of gout and joint infection can be very similar, get medical attention if you experience severe joint pain, redness, swelling, and stiffness. Depending on your symptoms, your provider may draw fluid off of the affected joint to confirm the diagnosis and rule out an infection. —Dr. Schwartz
Treatments for gout on the foot
If you suddenly feel pain, redness, swelling, and stiffness in a joint, see your doctor. A gout attack can look similar to an infection inside the joint. But that needs urgent treatment. So getting a proper diagnosis is important.
The doctor may diagnose you based on your symptoms, but they may also use a needle to draw fluid from the joint. This is sent for analysis to confirm the diagnosis.
Then, gout is treated with a combination of medications and other procedures, depending on how severe it is.
The pain usually gets better in 4 to 12 hours. But the swelling and discomfort might stay around for a few days to a few weeks. If it still hurts after taking medication or getting injections, call your doctor.
Your doctor might also order lab work if you start a new medication to treat your gout. People who get frequent flare-ups might need X-rays to look at the damage in their joints.
Medication
- Gout attacks can be treated with two medications: indomethacin (a powerful anti-inflammatory) or colchicine (a medication that helps reduce joint inflammation).
- Repeated attacks can be treated with allopurinol, which helps prevent uric acid crystals from forming.
- Steroids. Patients with very painful attacks or attacks on more than one joint might be given a short course of oral steroids. These have a strong anti-inflammatory effect that can reduce pain and swelling.
Procedures
- Injections. Your doctor might give you a cortisone shot. This can help reduce inflammation to reduce pain and swelling.
- Surgery. Rarely, gout can cause severe deformity in your joints and you may need surgery. The surgery will remove the calcium deposits (tophi). Or replace the damaged joint cartilage.
How do you get gout?
There are a few risk factors that increase your chances of getting gout or of triggering a gout attack. They include:
- Diet high in purines, including red meat, organ meats, and seafood
- Drinking a lot of sugary beverages
- Alcohol consumption
- Obesity
- Medical issues such as high blood pressure, kidney disease, and diabetes
- Medications – diuretics (which increase water you expel) and low-dose aspirin
- Family history of gout
- Male
- A recent surgery or injury
Pro Tip
One of the first places gout attacks is the great toe—although it can be just about any joint. Certain foods like red meat, seafood, sugary beverages, and even beer can help set it off. Gout attacks can become chronic and lead to destruction of the joint, so it’s important to avoid risk factors (i.e. certain foods) and manage attacks as they occur. —Dr. Schwartz
What foods cause gout?
These foods can increase uric acid in your blood, increasing your risk of gout. Reducing the amount of uric acid may help stop attacks from happening.
- Red meat and fatty poultry (any protein high in saturated fat)
- Organ meats
- High-purine seafood like anchovies, shellfish, sardines, and tuna
- Alcohol, especially beer
- Sugary drinks
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