Gout is a type of inflammatory arthritis that affects joints near the ends of limbs, including the ankles.
Gout develops when uric acid crystals form in the joints and soft tissues, triggering inflammation.
Read on to learn more about gout in the ankle and some treatment options for this complaint.
Gout is a form of arthritis that causes inflammation in any joint. Arthritis refers to a wide range of conditions that cause joint disease or pain.
Arthritis is extremely common but still relatively poorly understood. It can affect people of any age, sex, race, or ethnicity.
More than 50 million adults and roughly 300,000 children in the United States currently have arthritis.
Gout causes inflammation in the joints and the soft tissues surrounding them. This inflammation tends to cause:
- warmth around the affected area
- swelling of the joint and surrounding area
- tenderness in the affected area
- flushed, shiny skin around the affected area
- severe, intense pain
In many cases, gout usually just affects the big toe, but it can also affect other joints, such as those in the ankles, knees, and feet.
Gout often causes symptoms to come and go in periods of remission (periods with no symptoms) and flares (periods with active symptoms).
If uric acid levels are too high for too long, chalk-like deposits called tophi may form around affected joints and soft tissue, creating visible lumps.
Chronic gout and tophi may also cause permanent joint damage and disability.
Hyperuricemia is a condition wherein uric acid levels in the body are too high. As uric acid levels increase, symptoms of gout may start to appear.
When the body breaks down purines, it produces uric acid. Protein-rich foods contain purines.
As uric acid levels rise, the kidneys cannot remove it from the blood as effectively. When this happens, the uric acid deposits in the joints and soft tissues as microscopic, sharp, spike-like crystals.
The immune system responds to uric acid crystals and creates inflammation around the affected area.
Certain risk factors seem to increase the likelihood that gout will develop. These include:
- Sex: Males are three times more likely to develop gout than females.
- Age: Males tend to develop gout between the ages of 30–45 years. Females tend to develop it between the ages of 55–70 years.
- Certain medical conditions: A range of conditions seem to increase uric acid levels and the risk of developing gout,
- congestive heart failure
- high blood pressure
- heart disease
- metabolic syndrome and insulin resistance
- kidney disease or injury
- some forms of anemia (low red blood cell count)
- Family history: When a person has a family member with gout, it increases their own risk of developing the condition.
- Certain medications: Taking medications that increase uric acid levels could result in a person developing gout. These include:
- medications for heart disease and high blood pressure, such as diuretics (water pills) and beta-blockers
- aspirin (low dose)
- cyclosporine (an anti-organ rejection medication)
- some cancer medications and medications used to treat autoimmune conditions
- niacin (a cholesterol-lowering medication)
- Lifestyle factors: When a person regularly consumes alcohol and foods that contain high levels of purines, they may experience gout.
A doctor who specializes in arthritis, or a rheumatologist, will diagnose the condition.
To diagnose gout, the rheumatologist will physically examine the affected joints and the areas around them. They will also ask questions about the person’s symptoms and their medical and family history of gout.
The rheumatologist may also run a blood test to check the person’s uric acid levels during and between episodes.
They may also perform a synovial fluid analysis. During this procedure, the rheumatologist will take tiny samples of fluid from affected joints and look for uric acid crystals, white blood cells, and signs of infection.
During a gout flare, there are several at-home remedies that may help reduce the pain. These include:
- taking over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen
- taking prescription anti-inflammatory medications, such as NSAIDs, corticosteroids, colchicine, or prednisone
- applying ice wrapped in a cloth or towel several times daily
- staying hydrated but avoiding sweet drinks and alcohol
- elevating the affected joint several times per day
- resting the joint
- reducing or managing stress
A doctor may also prescribe medications between gout flares to help reduce uric acid levels, sometimes in combination with a low dose of colchicine. For example:
- Allopurinol and febuxostat reduce natural uric acid production.
- Probenecid helps the kidneys eliminate uric acid.
- Pegloticase may work when other medications do not lower uric acid levels.
The doctor may also change someone’s medications if they are contributing to their gout.
Several lifestyle habits also tend to reduce the risk of experiencing further gout flares or worsening flares. These include:
- staying hydrated and avoiding sugary drinks
- getting regular exercise
- losing weight (if necessary) or maintaining a moderate body weight
- managing or reducing stress
- learning ways to manage symptoms, such as through
self-management education programs
- eating a healthy, balanced diet
- avoiding or limiting drinks with fructose or high fructose corn syrup
- limiting or avoiding foods and drinks that are rich in purines, such as:
- bacon, turkey, beef, chicken, duck, ham, pork, veal, and venison
- scallops, mussels, crab, oysters, lobster, and shrimp
- anchovies, sardines, haddock, cod, trout, and herring
- liver, offal, and tripe
- avoiding or limiting alcohol consumption
- consuming whole cherries or unsweetened cherry juices
- drinking one glass of skimmed milk daily
People with severe gout may require surgery to remove tophi or repair joint damage.
When gout symptoms first appear, a person should talk with a doctor as soon as possible.
Gout is often manageable using preventive medications and implementing certain lifestyle changes, such as reducing the intake of foods that contain purines.
Some people also experience infections with gout, which require immediate medical attention to reduce the risk of serious complications.
Gout is a type of arthritis that causes inflammation and severe, sudden pain in the joints.
Several medications and lifestyle habits can help manage gout symptoms. A person should talk with a doctor when gout symptoms first occur.