Gout in the Big Toe Joint
Gout is a condition that often affects the big toe joint causing redness, heat, swelling and extreme tenderness. A patient with gout will often say that they can’t fit into shoes because the foot hurts so bad. They can’t move the big toe without pain. Even a bed sheet resting on the foot can cause excruciating pain. So what is gout in the foot?
What Causes Gout?
Gout is a form of arthritis (inflammation of the joint). In short, it inflammation caused by the buildup of crystals within the joint. Although gout typically produces pain in the big toe joint, it can occur in other joints such as the ankle, knee and elbow. But it is far more common in the joint at the base of the big toe joint (referred to by doctors as the first metatarsal phalangeal joint).
Although gout usually only causes joint pain, it is actually a metabolic disorder, not just a joint problem. People who get gout are unable to properly process and remove some of the byproducts of the food they eat. As a result, uric acid crystals gradually build up in the blood stream.
Once the concentration of uric acid in the blood gets high enough, sodium urate (uric acid) crystals start to get deposited in areas of slower temperature and decreased blood flow, like the big toe joint.
We can use an analogy to explain how this happens. Take a glass of iced tea. If you put in a couple of spoonfuls of sugar and stir, the sugar crystals will dissolve. If you keep adding sugar, sooner or later the crystals will stop dissolving and settle to the bottom of the glass.
If you now take the glass of tea and heat it, the crystals will dissolve. But as the glass of tea cools, the sugar crystals will start to form and again settle in the bottom of the glass.
This is basically what happens when the blood containing all of the uric acid flows through the big toe joint. The temperature is lower at the end of the foot toward the toes. Crystals start to form in the big toe joint.
Once the uric acid crystals have formed within the big toe joint, inflammation begins. What you see is a warm, red, swollen and very painful joint.
Who Gets Gout?
Gout has been described as the “affliction of Kings” and a “disease of the aristocracy.” It used to be that only those lucky, rich, members of the royal family would get the disease. For a long time (before we understood the biochemistry behind the disease, it was thought that it must be some inherited problem that only affected the royal families.
It turns out that gout has a lot to do with diet. To get gout, you have to have a diet rich in purines. Purines are found naturally in very high concentration in meat, seafood and beer
The reason that kings and queens used to only get is simple. They were the only ones who could afford to eat enough meet and alcohol to develop gout. The average people (the peasant workers) just didn’t eat the same food.
Today the typical North American diet is loaded with purines. In one year each American eats an average of 200 pounds of meat. Now that you can get a hamburger off the dollar menu, it is easier than ever before to fill up on the food that causes attacks of gout.
What Puts You at Risk for Gout?
Once you eat all of that food rich in purines, it is up to your kidneys to filter them out of the blood and excrete them in the urine. Some people have an inherited tendency to accumulate (build up) uric acid. These people are more at risk of having an attack of gout. But many other factor an affect you ability to remove uric acid from the blood. Kidney disease, high blood pressure (hypertension), diabetes, obesity, chemotherapy, stress, surgery and some medications and vitamin supplements can increase your risk of a gouty attack.
How Do I Know if I Have Gout?
You might have gout if you have:
• Pain in the big toe joint or ankle without any specific trauma or injury
• Pain gets worse as with activity (walking, running, or standing)
• You find it hard to participate in some activities
(such as running, climbing, cycling, hiking, rollerblading or skiing)
• Pain in the big toe joint or ankle, even at rest
• You noticed swelling or redness around the big toe joint
• A tender spot at the base of the big toe or near the ankle or midfoot
• Big toe joint hurts much worse with tight shoes
• You had a gradual increase in pain after some activity
• Limping or changes in the way that you walk
What will the Foot Doctor do for Gout in the Big Toe Joint?
Your doctor visit will begin with the doctor taking a complete medical history to make sure he/she has the full story. A physical exam will be performed. X-rays of the foot and toes will also be taken to further evaluate the condition and make sure that there is no risk for other less common, but dangerous conditions (such as a foot fracture, bone infection or bacterial infection that produces gas in the tissues). Although MRI, CT scan, Ultrasound and bone scans can all be performed to get more detail than can be seen on x-ray, it is usually not needed. MRI shows inflammation much better than an X-Ray, but MRI is usually only done if an infection, fracture or dislocated joint is suspected.Sometimes it is necessary to perform blood tests to see if the White Blood Cell count is elevated and determine kidney function before starting treatment.
Can X-Rays show Gout?
Yes and No. In most cases, the X ray is normal during the initial attack of gout. However, if the joint is really packed with crystals, the joint space (that is usually black) will look opaque or grey on xray.
If you have had many gout attacks, there are changes that occur in the joint that only happen with gout. Little erosion (areas where the bone dissolved) in the joint (where the joint capsule attaches to the bone) begin to show up on xray. Some people refer to these areas of missing bone as “rat-bite lesions” because it looks like a rate took a bite out of the edge of the bone. Doctor’s call this Martel’s sign.
Can a Blood Test Diagnose Gout?
Yes and No. If your blood is drawn just before an attack of gout, the uric acid level will be very high. Once the attack of gout begins, all of that uric acid leaves the blood stream and ends up in the joint in the form of crystals.
So many times a doctor will draw some blood and check the uric acid level when the patients is suspected of gout. But the uric acid isn’t in the blood anymore, it is in the joint. So the blood test comes back normal. And the doctor (incorrectly) tells the patient that he or she doesn’t have gout.
If the uric acid level happens to remain high during the attack, a blood test can be used to diagnose gout, but it isn’t very reliable.
Best Way to Diagnose Gout
The most accurate way to diagnose gout is with joint aspiration. The foot doctor draws a small sample of joint fluid out and looks at it under a microscope. During a gouty attack, the synovial fluid is just chock-full of little need-like rhomboid shaped crystals. Then we know for sure that all these tiny sharp needles poking the inside of the joint are causing the pain and inflammation.
Treatment of Gout
The good news about attacks of gout is that once diagnosed, it can be quickly treated. With the correct treatment, the pain will be gone in a few hours to a couple of days.
Most initial treatments for gout target the inflammation in the joint. If joint aspiration was performed, steroids can be injected right into the joint to stop all of the inflammation and pain.
But the mainstay of treatment for gout involves powerful oral anti-inflammatories medications. Colchicine and Indomethacin are the drugs most often prescribed for gout. They are much more effective than Tylenol, ibuprofen and other NSAIDs. Most people will generally get relief from a gouty attack by the time they have taken a few of these pills.
If someone has repeated or recurring attacks of gout, treatment starts with diet modification. A low-purine diet is often all that is needed to prevent gout from happening again.
If after modifying the diet, you still keep having more bouts of gout, other medicines can help. Allopurinal is a medication often prscribed for gout. It blocks an enzyme called xanthin oxidase. Blocking this enzyme decreases the amount or uric acid you body produces and hence, can decrease the chances for gout attacks. But don’t ever atart taking allupruinol during a gout attack, as it might actually backfire and make the attack worse.
When to See a Foot Doctor for Gout
Any time you have pain, swelling and redness in a joint you should consider this a medical emergency. You must seek help right away. Gout is very painful and that alone is reason enough to get help. But even more concerning is that other conditions that look like gout can be dangerous; even life threatening.
Charcot arthropathy is an emergency that can look like gout, but is actually more serious. It is most common in people with diabetes. It is important to start treatment for Charcot right away to prevent further damage and the potential for losing the foot to an amputation.
Soft tissue infections and infection arthritis (where there is bacteria growing within the joint) are both absolute emergencies that can look a lot like gout. Without treatment foot and joint infections can lead to an amputation or even death if sepsis (an infection in the blood stream) develops.
Because gout can look a like some very serious problems, you should immediately see a foot and ankle specialist if you have a red, hot painful, swollen foot or big toe joint. If your doctor’s office says they can’t see you right away, call someone else who will see you the same day. Otherwise, call 911 or head to the emergency room. Whatever you do, don’t wait.
click to viewGout Diet Instructionsfor Dr. Segler’s gout patients in printable PDF format
click to viewGout Medication Instructionsfor Dr. Segler’s gout patients printable PDF
Dr. Christopher Segler was selected in 2010 as one of “America’s Top Podiatrists.” He has a podiatry house calls practice in the San Francisco Bay Area. If you have gout and need pain relief right away, he makes podiatry emergency house calls 24/7. If you think you might have gout and would like to speak directly with him to ask a question, you can call him (415) 308 0833.
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FAQs
How do you treat gout in the big toe? ›
Non-steroidal anti-inflammatory drugs (NSAIDs) are usually recommended as the first treatment for gout. They work by reducing pain and inflammation during an attack. NSAIDs used to treat gout include naproxen, diclofenac and etoricoxib.
Is gout in the big toe serious? ›Gout occurs without warning. Anyone experiencing intense pain on the big toe, followed by warmth, tenderness, redness or discoloration, should immediately seek medical attention. If a person does not receive treatment for gout, it can lead to joint damage over time, including bone erosions and arthritis.
What triggers gout in big toe? ›Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines — substances that are found naturally in your body.
Can you get gout in just your big toe? ›Gout usually occurs in only one joint at a time. It is often found in the big toe. Along with the big toe, joints that are commonly affected are the lesser toe joints, the ankle, and the knee.
What stops gout immediately? ›Here's what you can do when a gout flare starts to ease the pain and reduce the risk of others. Take Medicine You Have on Hand. Start treatment immediately with over-the-counter ibuprofen (Motrin, Advil) or naproxen (Aleve), but never take aspirin, which can worsen a flare.
What is the fastest way to flush gout? ›Drinking water may flush uric acid crystals out of your system. Preliminary research suggests that adequate water consumption during the 24-hour period before a gout flare can decrease recurrent gout attacks.
How long does gout last in the big toe? ›An attack of gout usually lasts 5 to 7 days, then gets better. It may not cause lasting damage to joints if you get treatment immediately. Ask for an urgent GP appointment or call 111 if: the pain is getting worse.
Does gout in big toe go away? ›An acute gout attack will generally reach its peak 12-24 hours after onset, and then will slowly begin to resolve even without treatment. Full recovery from a gout attack (without treatment) takes approximately 7-14 days.
Should I walk with gout? ›It is safe for people to walk with gout. In fact, doing joint friendly activities such as walking can help improve gout-related pain. Gout is a form of arthritis that usually affects the big toe joint, but it can also affect the lesser toes, ankles, and knees.
Can gout be caused by stress? ›Gout attacks may be triggered by any of the following: Drinking alcohol. Eating a lot of protein-rich foods. Emotional stress.
Can you lose a toe from gout? ›
Uncontrolled gout can lead to amputation, but amputations in patients with gout are rarely described in the literature. It is well known that patients with diabetes are at increased risk for requiring amputation procedures, along with subsequent adverse health sequelae and mortality (4,5).
What does gout in your big toe feel like? ›Joints Affected by Gout
Big toe: Sudden pain that is tender to the touch, visibly red, and difficult to put weight on. Mid-foot: Tingling, followed by increased onset of pain that can be difficult to put weight on. Ankle: Burning and tingling pain and swelling that can prevent walking.
There is no proof that consuming or using apple cider vinegar can help prevent or treat gout. However, certain chemicals in apple cider vinegar, namely acetic acid, may lower the risk of developing conditions that can increase the likelihood of gout, such as obesity, diabetes, and high blood pressure.
Does soaking in hot water help gout? ›The key hypothesis is that these urate crystals dissolve on warming. Hence, by warming the joint concerned in hot water, and moving the joint around to encourage diffusion, the urate concentration is reduced and crystals no longer form, provided the treatment is continued.
Can you rub gout away? ›It can be! As gout is inflammatory, the anti-inflammatory relief massage may bring can be immensely helpful. Different types of massage techniques such as Thai massage and those aimed at helping flush toxins from your body are most beneficial when getting a massage for gout.
Can you get rid of gout without medicine? ›Most gout attacks will go away by themselves in several weeks, even without treatment.
Why is my gout not going away? ›Repeated bouts of gout can lead to gouty arthritis, a worsening form of arthritis. If symptoms of gout persist, Dr. Diri suggests seeing your primary care provider. There, the provider will rule out other potential causes of joint pain and inflammation, such as infection, injury, or another type of arthritis.
How do you break up gout crystals? ›- Nonsteroidal anti-inflammatory drugs (NSAIDs). These might include prescription medications such as Tivorbex or Celebrex or over-the-counter medications such as Aleve or Advil.
- Corticosteroids. These medications can bring down inflammation. ...
- Colchicine.
Eat: Citrus Fruits
Grapefruit, oranges, pineapples, and strawberries are all great sources of vitamin C, which lowers your uric acid levels and helps prevent gout attacks.
Bananas are low in purines and high in vitamin C, which makes them a good food to eat if you have gout. Changing your diet to include more low-purine foods, like bananas, can lower the amount of uric acid in your blood and reduce your risk of recurrent gout attacks.
Is lemon good for uric acid? ›
Lemon juice may help balance uric acid levels because it helps make the body more alkaline. This means it slightly raises the pH level of blood and other fluids. Lemon juice also makes your urine more alkaline.
What are the 4 stages of gout? ›Gout progresses through four clinical phases: asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout (intervals between acute attacks) and chronic tophaceous gout. Demonstration of intra-articular monosodium urate crystals is necessary to establish a definitive diagnosis of gouty arthritis.
Does wearing shoes make gout worse? ›Poorly Fitting Shoes
Any kind of damage or trauma to an area may cause a gout pain flare in susceptible people. Shoes that rub the toe can contribute to an attack so it's best to make sure that the toe area of your shoes is wide enough to accommodate your feet without pinching or rubbing.
Heat and ice may be effective for other types of arthritis pain, but these treatments aren't recommended for gout. Heat may contribute to inflammation and ice may cause uric acid to crystallize faster. Patients with recurring attacks of gout often need medication to prevent damage to cartilage, bones, and kidneys.
What emotion causes gout? ›Stress and Injury
Emotional stress can also bring on a gout attack. So can physical trauma to the foot (such as might occur during running), which may release some crystals and cause an inflammatory reaction.
Gout flares often start suddenly at night, and the intense pain may be bad enough to wake you up. In addition, your joint may feel swollen, red, warm, and stiff. Gout flares usually occur in one joint and can be triggered by certain foods, alcohol, certain medications, physical trauma, or certain illnesses.
Is gout a mental disorder? ›Gout characteristics associate with depression, but not anxiety, in primary care: baseline findings from a prospective cohort study. Joint Bone Spine.
How do doctors test for gout? ›Your doctor may use a needle to draw fluid from your affected joint. Urate crystals may be visible when the fluid is examined under a microscope. Blood test. Your doctor may recommend a blood test to measure the levels of uric acid in your blood.
Does gout show up on xray? ›An x-ray of the joint may show the deposition of uric acid crystals. However, x-rays can be normal even when gout is present. Experts estimate that chronic gout must be present for 5 to 10 years before joint changes can be seen on an x-ray. Most gout cases are diagnosed with a joint fluid analysis.
What is the best test for gout? ›Synovial fluid test
This test looks at whether you have urate crystals in the joint fluid, which could mean you have gout. This is considered the most accurate test for diagnosing gout. A synovial fluid test only takes a few minutes to complete.
Does sugar make gout worse? ›
Takeaway. The consumption of natural sugar fructose and the man-made sweetener high fructose corn syrup appear to increase the risk of gout. A gout-friendly diet combined with a few lifestyle changes can help control uric acid levels and reduce flare-ups from gout.
Is it gout or arthritis in my big toe? ›Gout. For many people, pain and swelling in the big toe, especially at the joint where the toe meets with the foot, is the first symptom of gout. Gout is a type of arthritis that occurs because elevated levels of uric acid in the blood accumulate in and aggravate joints, causing inflammation.
How long does gout last in the big toe? ›An attack of gout usually lasts 5 to 7 days, then gets better. It may not cause lasting damage to joints if you get treatment immediately. Ask for an urgent GP appointment or call 111 if: the pain is getting worse.
Does gout in big toe go away? ›An acute gout attack will generally reach its peak 12-24 hours after onset, and then will slowly begin to resolve even without treatment. Full recovery from a gout attack (without treatment) takes approximately 7-14 days.
Can you get rid of gout once you have it? ›Patients can never be cured of gout. It is a long-term disease that can be controlled by a combination of medication to control the uric acid level, and anti-inflammation drugs to treat a flare-up. “Lowering the level of uric acid is key to treating gout, and patients must understand this.
Can you get rid of gout without medicine? ›Most gout attacks will go away by themselves in several weeks, even without treatment.
Why is my gout not going away? ›Repeated bouts of gout can lead to gouty arthritis, a worsening form of arthritis. If symptoms of gout persist, Dr. Diri suggests seeing your primary care provider. There, the provider will rule out other potential causes of joint pain and inflammation, such as infection, injury, or another type of arthritis.
Can you lose a toe from gout? ›Uncontrolled gout can lead to amputation, but amputations in patients with gout are rarely described in the literature. It is well known that patients with diabetes are at increased risk for requiring amputation procedures, along with subsequent adverse health sequelae and mortality (4,5).
How do you break up gout crystals? ›- Nonsteroidal anti-inflammatory drugs (NSAIDs). These might include prescription medications such as Tivorbex or Celebrex or over-the-counter medications such as Aleve or Advil.
- Corticosteroids. These medications can bring down inflammation. ...
- Colchicine.
The key hypothesis is that these urate crystals dissolve on warming. Hence, by warming the joint concerned in hot water, and moving the joint around to encourage diffusion, the urate concentration is reduced and crystals no longer form, provided the treatment is continued.
What fruit is good for gout? ›
Eat: Citrus Fruits
Grapefruit, oranges, pineapples, and strawberries are all great sources of vitamin C, which lowers your uric acid levels and helps prevent gout attacks.
Bananas are low in purines and high in vitamin C, which makes them a good food to eat if you have gout. Changing your diet to include more low-purine foods, like bananas, can lower the amount of uric acid in your blood and reduce your risk of recurrent gout attacks.
What drinks to avoid when you have gout? ›Drinking sugary beverages, such as sodas sweetened with high fructose corn syrup, fruit juices or other sugar-containing drinks, is associated with gout. Notable exception: cherries, especially tart cherries, may be beneficial for gout.