Gout

What Is Gout?
Gout is a disorder that results from the build-up of uric acid in the tissues or a joint. It most often affects the joint of the big toe.

Causes
Gout attacks are caused by deposits of crystallized uric acid in the joint. Uric acid is present in the blood and eliminated in the urine, but in people who have gout, uric acid accumulates and crystallizes in the joints. Uric acid is the result of the breakdown of purines, chemicals that are found naturally in our bodies and in food. Some people develop gout because their kidneys have difficulty eliminating normal amounts of uric acid, while others produce too much uric acid.

Gout occurs most commonly in the big toe because uric acid is sensitive to temperature changes. At cooler temperatures, uric acid turns into crystals. Since the toe is the part of the body that is farthest from the heart, it’s also the coolest part of the body – and, thus, the most likely target of gout. However, gout can affect any joint in the body.

The tendency to accumulate uric acid is often inherited. Other factors that put a person at risk for developing gout include: high blood pressure, diabetes, obesity, surgery, chemotherapy, stress, and certain medications and vitamins. For example, the body’s ability to remove uric acid can be negatively affected by taking aspirin, some diuretic medications (“water pills”), and the vitamin niacin (also called nicotinic acid). While gout is more common in men aged 40 to 60 years, it can occur in younger men as well as in women.

Consuming foods and beverages that contain high levels of purines can trigger an attack of gout. Some foods contain more purines than others and have been associated with an increase of uric acid, which leads to gout. You may be able to reduce your chances of getting a gout attack by limiting or avoiding shellfish, organ meats (kidney, liver, etc.), red wine, beer, and red meat.

Symptoms
An attack of gout can be miserable, marked by the following symptoms:

  • Intense pain that comes on suddenly – often in the middle of the night or upon arising
  • Signs of inflammation such as redness, swelling, and warmth over the joint.

Diagnosis
To diagnose gout, the foot and ankle surgeon will ask questions about your personal and family medical history, followed by an examination of the affected joint. Laboratory tests and x-rays are sometimes ordered to determine if the inflammation is caused by something other than gout.

Treatment
Initial treatment of an attack of gout typically includes the following:

  • Medications. Prescription medications or injections are used to treat the pain, swelling, and inflammation.
  • Dietary restrictions. Foods and beverages that are high in purines should be avoided, since purines are converted in the body to uric acid.
  • Fluids. Drink plenty of water and other fluids each day, while also avoiding alcoholic beverages, which cause dehydration.
  • Immobilize and elevate the foot. Avoid standing and walking to give your foot a rest. Also, elevate your foot (level with or slightly above the heart) to help reduce swelling.

The symptoms of gout and the inflammatory process usually resolve in three to ten days with treatment. If gout symptoms continue despite the initial treatment, or if repeated attacks occur, see your primary care physician for maintenance treatment that may involve daily medication. In cases of repeated episodes, the underlying problem must be addressed, as the build-up of uric acid over time can cause arthritic damage to the joint.


Trauma & Injuries


Urgent Access & Walk-in Hours

FAAWC understands the challenge of finding foot and ankle care that is quickly accessible. That's why we offer emergency/urgent appointments on an as-needed basis. Please call 740-363-4373 for availability. From noon to 3 p.m. Fridays, FAAWC is open for ANY walk-in patients who do not have a scheduled appointment.


Dr. Anderson: Foot and Ankle Trauma

Sports Injuries Many sports are hard on the feet because of quick and repetitive movements, constricting footwear and/or increased exposure to injury or trauma.

Shin Splints Pain on either side of the leg bone that is caused by muscle or tendon inflammation.

Broken Ankle Can involve one or more of the bones, as well as injury to the surrounding connecting tissues or ligaments.

Ankle Sprains Caused by an unnatural twisting or force on the ankle bones of the foot, which may result in excessive stretching or tearing of one or more ligaments on the outside of the ankle.

Stress Fractures Incomplete cracks in bone caused by overuse. With complete rest, stress fractures in toes or any bones of the foot heal quickly. Extra padding in shoes can help prevent the condition. Left untreated, stress fractures may become complete bone fractures, which require casting and immobilization.

Chronic Lateral Ankle Pain Recurring or chronic pain on the outside part of the ankle that often develops after an injury such as a sprained ankle.

Osteochondritis (stiff ankle) A lesion that usually causes pain and stiffness of the ankle joint and affects all age groups. Osteochondritis is caused by a twisting-type injury to the ankle.

Osteochondromas Benign bone tumors that form in the bone beneath the toenail. Osteochrondromas account for about half of all benign bone tumors, and they occur mostly in children and young adults.

Learn more about selecting the proper athletic shoes with our athletic shoe guidelines.