Gout

Gout, or a gouty attack, is caused by an increase in the amount of uric acid crystals in the body.

Symptoms
Redness, swelling and intense pain characterize what most people experience during an acute gouty attack.  Often the light touch of bedsheets can elicit pain.  In the foot, pain and swelling usually occurs in the great toe joint; which is the furthest joint (coolest) from the heart, or the body’s core heat.

Causes
Many foods contain high levels of purines of which uric acid is a byproduct. These foods would include red meat, shell fish, red wine and alcoholic beverages as a group.  Two other inherited causes for a gouty attack include (1) the body’s overproduction of uric acid crystals and (2) the body’s inability to excrete normal amounts of uric acid crystals.  Medication, such as high blood pressure medication (water pills), can lead to a build-up of uric acid crystals.

In the past gout has been referred to as “the rich man”s disease”. This is because during the middle ages only the wealthy people were able to afford to eat these ”rich” foods. Consuming foods and alcoholic beverages that may contain high levels of purines may contribute to an attack of gout.

Diagnosis
Your Podiatric Physician can usually make this diagnosis after a thorough history and physical.  In certain cases x-rays and blood tests are often ordered to confirm the increase in uric acid and to determine whether or not there is another cause of the inflammation.

Treatment
Treatment typically begins with prescription oral anti-inflammatory medication.  This, together with a change your diet, can reduce the symptoms of a gouty attack.  However, significant reduction in the amount of gout producing foods including shellfish, red wine, red meat, etc. is necessary.  Severe acute attacks may require oral steroids or a steroid injection to the affected joint to allow for immediate relief.  If you experience repeated gout attacks your Podiatric Physician may refer you to your primary care physician for long term uric acid management.

In cases where high levels of uric acid crystals are allowed to build up within a joint (tophi), surgical removal may be indicated.