Gout is a form of arthritis that causes swelling, tenderness, and extreme pain. It typically affects the joints and often begins at the big toe.
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), gout flares often begin in the big toe.
Gout attacks can occur unexpectedly and without warning, often in the middle of the night, initially causing intense pain. A gout episode can last for a few days or weeks. Some people may experience flares of gout frequently, whereas others may not have a gout flare for years at a time.
Gout occurs due to an excess buildup of uric acid crystals in the joints and soft tissue, causing inflammation and intense pain.
Gout attacks involve intense throbbing or burning joint pain, which occurs suddenly, followed by swelling, tenderness, warmth, and redness or discoloration.
It can affect a person’s hands, elbows, knees, feet, and toes.
One 2018 article states that for some people, the pain can be so severe that they cannot tolerate the weight of a blanket. The symptoms are typically at their worst within 6–12 hours. The affected joint, or big toe, will recover in 1–2 weeks.
The following are indications that a person is experiencing a gout attack in the big toe:
- intense joint pain on the big toe
- rapid onset
- swelling and redness or discoloration
- difficulty moving
Due to severe pain and swelling, people who experience gout attacks may find it challenging to walk or stand.
A person can try the following to treat gout in the big toe:
According to the Arthritis Foundation, if a person experiences a gout flare in the big toe, they should call a doctor to make an appointment.
In the meantime, they can:
- Take medication: A person can take nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Aleve), ibuprofen, and celecoxib (Celebrex). However, low-dose aspirin may exacerbate a flare.
- Elevate the foot and apply ice: This may ease inflammation and pain. Elevate the foot so that it is higher than the chest. Use an ice pack and apply to the toe for 20–30 minutes, several times a day.
- Drink fluids: Avoid alcohol and sugary drinks. A person should aim for 8–16 cups of fluid per day, half of which should be water.
A person can also use a cane or other mobility aids when they walk to help relieve pressure on the toe. They also recommend cutting the big toe out of a pair of socks so that there is no pressure on the toe. Open toe shoes or sandals are an option.
A doctor may recommend lifestyle changes to prevent recurrent gout attacks along with prescribed medications.
The Centers for Disease Control and Prevention (CDC) recommend the following lifestyle changes:
- reducing alcohol intake and drinks with high sugars
- taking regular exercise and maintaining a moderate weight
- avoiding foods that may cause gout attacks, such as seafood, organ meat, and red meat
Gout treatment usually involves medications.
A doctor will choose medicines based on your condition. According to NIAMS, medication can treat gout attack symptoms, prevent future attacks, and lower the chance of gout complications, such as tophi development.
Tophi occur when the uric acid crystals build up and form small lumps. They can occur anywhere but commonly develop at pressure points, such as the elbows, or around hand or foot joints.
Medication can include:
- corticosteroids, such as prednisone
- colchicine, such as Colcrys or Mitigare
Gout occurs due to an excess buildup of uric acid, or hyperuricemia.
According to the National Institutes of Health (NIH), hyperuricemia is the main risk factor for developing gout. However, a quarter of those with hyperuricemia do not develop gout.
When the body breaks down purines, it produces uric acid. Typically, the kidneys remove a certain amount of uric acid in the urine. However, when they are unable to remove enough uric acid, uric acid crystals can form in the joints and soft tissues, causing swelling and pain.
Genetics can also increase the chance of developing gout.
According to the CDC, other factors that may increase the likelihood of gout include:
- Diet: Food can play a role in the development of gout symptoms. Eating seafood, red meat, and drinking alcohol raises uric acid levels in the body.
- Weight: Having overweight increases the chance of developing gout.
- Medications: Certain medications, including diuretics and low-dose aspirin, are associated with gout risk because they increase the level of uric acid in the body.
- Other medical conditions: High blood pressure, diabetes, and kidney disease can increase gout risk.
NIAMS recommend avoiding foods high in purine, such as:
- seafood, including cod, salmon, and mussels
- organ meat
- red meat
- beverages high fruit sugars
Conversely, certain foods have the potential of lowering uric acid levels, the primary cause of gout attacks.
- Cherries: A study has shown that cherries might potentially help lower the level of uric acid in the body, thus reducing gout attacks. However, it would be best to consult a doctor first.
- Vitamin C: According to a 2017 review, consuming vitamin C may increase uric acid excretion.
- Coffee: One study suggests that people who drink coffee regularly are less likely to develop gout. However, more research is needed to confirm these findings.
According to the National Health Service (NHS) in the United Kingdom, some people with gout may develop complications, such as:
- Kidney stones: When urate crystals accumulate in the urinary tract, kidney stones may develop.
- Tophi: These are typically painless, but can appear in awkward places, such as the toes, and can drain white chalky material.
- Joint damage: Some people may experience gout attacks frequently, while others may never have flare-ups. Without treatment, the gout attacks may occur more frequently and cause permanent damage to the joints.
Gout can be debilitating, but there are many lifestyle and dietary changes that may help prevent gout:
- Maintaining a healthy body weight: Exercise and diet may help reduce uric acid levels in the blood.
- Reducing alcohol intake: Alcohol, especially beer and hard liquor, increases the risk of a gout attack. So, limiting or avoiding alcohol would help the body excrete excess uric acid in the urine.
- Drinking plenty of fluids: Stay hydrated and limit the intake of sugary drinks.
- Eat a low-fat and low-purine diet: Avoid food rich in purine, such as seafood and red meat. Instead, eat vegetables, low-fat dairy products, and plant-based proteins.
A doctor has to carry out several examinations to diagnose gout. One of the tests is a joint fluid test, which involves drawing fluid from the affected joint. The presence of urate crystals in the fluid is an indication of gout.
Doctors can also do blood tests to examine the uric acid levels in the body. However, the NIH state that some people with high uric acid may never develop gout symptoms, while those with low uric acid may experience gout attacks.
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.
Gout attacks typically begin in the big toe. Gout attacks can be excruciating and people typically need medication to lower the uric acid levels and prevent uric acid buildup and joint damage.
Lifestyle and dietary changes may help prevent future attacks.
As well as taking medication, a person can elevate the foot and apply ice to alleviate pain.