Foot & Ankle Specialists Serving the Conejo Valley

Gout

Gout is a very painful condition that often affects the foot. Patients often come to the office thinking they have gout when it is not and other patients clearly have gout and think that can’t possibly be true! So there is clearly confusion about what gout is and how it presents. Gout affects approximately 1% of the population so it is not very common. It occurs more often in men >40 yrs of age, however, women can get gout after menopause. The incidence of gout in a healthy premenopausal woman is very low.

The most frequent presentation of gout is in the big toe joint which becomes acutely red, warm, swollen and is exquisitely tender. It is painful even to light touch and most often patients are unable to walk without limping. Gout is caused by uric acid levels building up in the blood then precipitating/crystallizing in the joint. Gout crystals form at cooler temperatures which is why acute attacks often develop in the middle of the night and in the foot (coldest body part). Patients will either wake up in the middle of the night with pain or the next morning. Waking up with a red, swollen joint without a known injury is often exclusive to gout. However, if you have a swollen painful joint it could be arthritis or infection. Infection is much more likely when there is some sort of opening to allow bacteria to get deeper such as a bug bite, cut, or injury. If there is no opening, the chance of infection is very low.

Gout is exacerbated by certain foods such as organ meats (liver, pancreas), seafood, and alcohol. Ice usually alleviates pain in the foot but with gout it can actually make it worse (because uric acid precipitates at cooler temperatures). It can be helped by drinking lots of water, dairy products and cherry juice. It is associated with high blood pressure, kidney disease and obesity. It can also be caused by some medications such as low-dose aspirin (81 mg), some diuretics and some blood pressure medications.

The treatment of acute gout varies but is most often controlled with medication that is specific to acute gout or a steroid injection into the joint. It is recommended to have an aspiration of the affected joint to send the joint fluid to the lab and have it evaluated under a microscope. If there are crystals identified then you have a definitive diagnosis of gout and can be treated accordingly. Many people need an oral medication for long term management to prevent frequent flare ups but diet modification is also important. If gout is not properly managed then it can lead to very destructive changes in the joint (arthritis) or precipitation of crystals into non-joint spaces such as ears, elbows, and the heels. It can also damage the kidneys and heart thus controlling uric acid is very important and something that needs to be followed closely by your primary care doctor, endocrinologist or rheumatologist.

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