There’s no mistaking the symptoms of a gout attack. Gout can produce foot pain and swelling so excruciating that Hippocrates called it “the unwalkable disease,” referring to its immobilizing effects. People who are awakened by a gout attack often claim that the pain is so intense they can’t tolerate the feeling of a bedsheet on the affected joint.
Gout occurs when your body accumulates too much uric acid in your blood. Uric acid forms when your body processes purines, a substance that’s naturally found in many foods. Uric acid typically dissolves in your blood and passes through your kidneys. However, if too much uric acid builds up, or the kidneys have problems processing it, the acid can form into sharp, needle-like crystals around your joints.
Podiatrist Marshall L. Lukoff, DPM, FAAFS, of Foot Care Specialists, PC in Quincy and Dedham, Massachusetts, has the expertise necessary to determine whether the pain and swelling you’re experiencing are related to gout. After a thorough examination, Dr. Lukoff can develop a treatment plan to relieve your discomfort and reduce your risk of future attacks.
Why gout often attacks the feet
While gout can impact any joint, it most often affects joints in the feet. About 75% of patients experience their first gout attack in the joint at the base of their big toe. Ultimately, more than 90% of people with gout experience a flareup at this location, though the condition can also affect the ankles, knees, wrists, fingers, and elbows.
The joint at the base of the big toe may be more susceptible to gout because uric acid reacts to changes in temperature. When exposed to lower temperatures, uric acid transforms into crystals. Since the big toe is a limb that is the farthest from the heart, it also has the lowest temperatures, which can make it a welcoming environment for gout.
The tendency for gout to occur at night may happen for the same reason. Your body temperature tends to be about 1-2 degrees lower when you’re sleeping than when you’re awake. In addition, some of the water in your joints’ synovial fluid is reabsorbed by your body when you sleep. However, the level of uric acid in your joints remains constant, leaving a higher concentration of uric acid and an environment welcoming to the formation of uric acid crystals.
You can set off an attack of gout by injuring the affected joint. Other events, such as surgery or treatments that change your body chemistry, can also trigger gout. Even stubbing your toe can trigger a gout attack if the area has enough uric acid crystals in place.
How to recognize gout
The symptoms of your first gout attack will likely alert you that something is wrong. However, the symptoms can be so severe that you may attribute them to another medical condition, which could delay you in getting an accurate diagnosis.
Typical symptoms of gout include:
- Symptoms that develop suddenly and without warning, escalating to extreme intensity in just a few hours
- Pain so extreme at the affected joint that it’s often impossible to put weight on the area
- Symptoms so intense that they may awaken you from a sound sleep
- Swelling and/or redness at the site of the affected joint
- Fever and fatigue
While some gout attacks resolve on their own, the process can take days to weeks. Repeated attacks are called chronic gout and can cause permanent joint damage and lead to decreased range of motion.
Gout is treatable when identified early. Depending on your condition, you may get relief from acute attacks with non-steroidal anti-inflammatory drugs, such as ibuprofen, or an injection of corticosteroids. A drug called colchicine can help stop an acute attack if taken within the first 12-24 hours of symptoms.
When tolerable, ice packs applied to the affected area can help reduce pain and swelling. Rest and elevation of the affected limb can also help symptoms subside. Prescription pain relievers may be necessary for short-term relief of acute pain.
Once called the “disease of kings,” gout is associated with eating rich foods and consuming large amounts of alcohol, which were once only available to kings and the wealthy.
You can reduce your risk of suffering gout attacks by reducing your consumption of foods that can result in high levels of uric acid. These foods include shellfish, red meat, beans, red wine, and beer. Medications, such as allopurinol and probenecid, can also be prescribed to reduce the amount of uric acid in your body.
If you’re experiencing foot pain associated with gout, don’t delay in seeking relief. To learn more, schedule an appointment online or over the phone with Foot Care Specialists, PC today.