Gout is a form of arthritis that affects the joints and often begins at the big toe. Gout in the toes can lead to inflammation, pain, and joint stiffness.
Gout attacks can occur unexpectedly and without warning, often in the middle of the night, initially causing intense pain. A gout flare can last for a few days or weeks. Some people have frequent gout flares, while others may go several years before having another flare.
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Gout attacks involve intense throbbing or burning joint pain, which occurs suddenly, followed by swelling, tenderness, warmth, and redness or discoloration.
The following are indications that a person is experiencing a gout attack in the big toe:
- intense joint pain in 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.
According to the National Institutes of Health (NIH), hyperuricemia is the main risk factor for developing gout. However, a quarter of people 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 through urine. However, when they are unable to remove enough uric acid, crystals can form in the joints and soft tissues, causing swelling and pain.
Gout typically affects males more than females. However, females have higher levels of uric acid after menopause, which increases the risk of gout attacks. NIAMS states that being older also
Genetics can also increase the chance of developing gout.
According to the
- Diet: Food can play a role in the development of gout symptoms. Seafood, red meat, and alcohol can raise uric acid levels. A low-purine diet may help avoid gout.
- Weight: Being overweight increases the chance of developing gout.
- Medications: Certain medications, including diuretics and low-dose aspirin, have an association with gout risk because they increase uric acid levels.
- Other medical conditions: High blood pressure, diabetes, and kidney disease can increase gout risk.
- seafood, including cod, salmon, and mussels
- organ meat
- red meat
- sweetened foods, such as baked goods
- alcohol, and in particular, beer and distilled liquor
- beverages that are high in sugar
Conversely, certain foods may lower uric acid levels. They include:
- Cherries: A study has shown that cherries may help lower uric acid levels and reduce gout attacks. More studies are necessary, though.
- Vitamin C: According to a
reviewfrom 2017, vitamin C may increase uric acid excretion. Eating foods that contain vitamin C may be beneficial.
- Coffee: One
studysuggests that people who regularly drink coffee are less likely to develop gout. However, more research is necessary to confirm these findings.
A doctor has to carry out several examinations to diagnose gout.
Blood tests can assess uric acid levels in the body. However, the NIH states that some people with high uric acid may never develop gout symptoms, while those with low uric acid may experience gout attacks.
For this reason, a uric acid blood test cannot diagnose gout. However, it will help guide treatment and the doses of medication to use.
Joint fluid aspiration is the most helpful test to diagnose or confirm gout. In this test, urate crystals are visible. It is most useful soon after gout symptoms begin. It becomes more difficult for doctors to find the crystals over time because they dissolve and the body excretes them. A doctor may use ultrasound to guide this procedure.
An X-ray can detect bone erosion and calcifications, but these will only become visible as the disease progresses.
An experienced musculoskeletal radiologist may use a dual-energy CT scan to look for urate crystal deposits.
Gout happens when the body produces too much uric acid or does not excrete enough. Foods high in purines can trigger an attack. It commonly affects the joints of the lower extremities, such as the big toe, foot, ankle, or knee.
Pseudogout — also
Foods do not trigger pseudogout. It usually happens with older age, and genetic factors can play a role. It may also stem from metabolic causes, such as thyroid disease, iron overload, high calcium, and low magnesium levels.
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 a 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. A person should elevate the foot so that it is higher than the chest and apply a cool pack to the toe for 20–30 minutes several times a day.
- Drink fluids: A person should avoid alcohol and sugary drinks. They 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 can also cut the big toe out of a pair of socks, so there is no pressure on the toe. Open-toe shoes or sandals are an option.
Find out more about some home remedies for gout.
A doctor may recommend lifestyle changes to prevent recurrent gout attacks along with prescribed medications.
- 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 the condition. According to
Tophi occur when the uric acid crystals build up and form small lumps. They can happen anywhere but commonly develop at pressure points, such as the elbows or around the hand or foot joints.
To treat a flare, a doctor may recommend:
- a short course of oral corticosteroids, such as prednisone
- corticosteroid injections
- colchicine, such as Colcrys or Mitigare, taken for several days
To prevent flares, a doctor may prescribe one or more of the following:
- Allopurinol (Zyloprim) or febuxostat (Uloric): These reduce uric acid.
- Colchicine or NSAIDs: In the early stages, when the crystals are starting to dissolve, there is a higher chance of flare-ups. These drugs can help reduce this risk until allopurinol or febuxostat lower uric acid levels.
- Intravenous pegloticase (Krystexxa): This can help dissolve tophi in severe cases of gout that do not respond to other treatments.
According to the National Health Service (NHS) in the United Kingdom, some people with gout may develop complications, such as:
- Kidney stones: These may develop if urate crystals accumulate in the urinary tract.
- Kidney failure: Without treatment, urate crystals can build up in the kidneys, leading to kidney failure.
- 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, attacks may occur more frequently and cause permanent joint damage.
Gout can be debilitating, but many lifestyle and dietary changes can help prevent it, such as:
- 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. Limiting or avoiding alcohol helps the body excrete excess uric acid in the urine.
- Drinking plenty of fluids: A person should stay hydrated and limit their intake of sugary drinks.
- Eating a low-fat and low-purine diet: People should avoid food rich in purine, such as seafood and red meat. Instead, they can eat vegetables, low-fat dairy products, and plant-based proteins.
Gout can occur without warning. Anyone experiencing intense pain in a 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 a big toe. They can be excruciating, and people typically need medication to lower their uric acid levels and prevent uric acid buildup and joint damage.
Lifestyle choices, dietary changes, and medication can help prevent future attacks.
To relieve pain, a person can use NSAIDs as well as elevating the foot and applying ice.