Gout

What is Gout?

It is a common cause of arthritis (joint inflammation). It’s caused by a build-up of uric acid (hyperuricemia) in the blood, leading to crystals forming in the joint space.

These uric acid crystals inflame the surrounding tissue, triggering arthritis.

Excess uric acid can be due to a variety of causes, including:

  • Underexcretion. The kidneys are responsible for filtering out uric acid from the blood. In around 90% of cases, the kidneys fail to filter out enough uric acid, precipitating a build-up.
  • Overproduction. Due to genetics or diet, the body naturally produces too much uric acid, meaning your kidneys are overwhelmed.
  • Diet. Uric acid is produced from the breakdown of purines. Foods high in purines — like alcoholic beverages, red and organ meats, and seafood — will lead to higher purine levels and, by extension, raised uric acid production. Approximately 12% of gout in ankle cases can be attributed to diet.
  • Certain Medications. Certain medications, particularly blood pressure treatments, can cause higher uric acid levels. Cyclosporine is also associated with this condition.
  • Weight. Overweight individuals produce more uric acid, which the kidneys can struggle to eliminate.

There are many more risk factors for gout attacks. For example, middle-aged men and postmenopausal women are at greater risk, as are people with a family history of this condition. Recent surgery or trauma is associated with gout attacks, though the cause is unknown.

An episode of it is known as a “gout attack”. These attacks occur suddenly, even overnight, and are extremely painful. It is most frequently seen in the big toe — though other joints can be affected.

The most common symptoms of gout foot attack include:

  • Intense pain
  • Joint swelling
  • Redness
  • Joint stiffness
  • Warm joints
  • Tenderness in the joint

Gout attacks last a week or two before subsiding. In some cases, however, symptoms persist for years, especially if left untreated. Because the underlying cause of it is the same, attacks will likely recur again and again in the same joint or different joints.

All cases of this condition can benefit from seeing a foot doctor. In particular, patients struggling with sudden or severe joint pain should organize an appointment with a foot doctor for examination and treatment.

You can benefit from a session with an expert if you’ve experienced continual episodes or chronic conditions. They’ll be able to prescribe medication to reduce or prevent the incidence of attacks.

A foot doctor will review your medical history during an appointment and conduct a physical examination. They’ll feel the joint and ask you to perform some movements.

In addition, they’ll often take a sample of fluid from the joint to identify uric acid crystals and a blood sample to see if your blood uric acid levels are raised.

In some cases, an X-ray may also be taken to rule out other types of arthritis. Although relatively easy to diagnose, this condition can occasionally be confused with other conditions. MRI scans and ultrasounds are sometimes performed too.

There are two parts to treating this condition — symptom relief and uric acid reduction.

Immediate symptom relief involves using NSAIDs to reduce pain and swelling or steroids in severe cases. Some patients cannot take NSAIDs due to kidney problems, stomach ulcers, or other health problems.

Colchicine (Colcrys, Mitigare) — a gout-specific medication — is also used to provide fast relief within the first 24 hours of a gout attack.

To provide long-term prevention, the doctor uses “xanthine oxidase inhibitors” like allopurinol (Lopurin, Zyloprim) to reduce uric acid levels in the blood. Other gout foot prevention medications include febuxostat, pegloticase, and probenecid.

Lifestyle is a risk factor for this condition, and specific changes can reduce the incidence of attacks. Your foot doctor may also encourage you to:

  • Decrease your alcohol intake
  • Change your diet, avoiding purine-rich foods
  • Quit smoking
  • Commit to a weight loss and exercise program
  • Drink plenty of water

In severe cases with joint damage from hard deposits (tophi), surgery may be the last resort, including joint replacements, fusion, and tophi removal.

Our Foot Doctor can help provide relief.

Book an evaluation with Foot & Ankle Centers today.

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