Foot with painful toe joint and gout

Gout can affect anyone, although certain people are more at risk. 

What Is Gout?

Gout is a painful form of inflammatory arthritis that affects the joints in the feet. Often the first joint affected is the big toe joint. Gout is caused by buildup of uric acid, which is normally excreted by the body through the kidneys. Most often there is too much uric acid because the kidneys are unable to eliminate it. Uric acid forms needle-like crystals that can be very painful when high levels collect in the joints.

What Causes Excess Uric Acid in Gout?

Certain foods that contain purines and some drugs can raise the level of uric acid in the body when they are broken down. Although not everyone who eats these foods will develop gout, they are a contributing factor to developing this condition.  The following foods and drugs contain high levels of purines and should be avoided or decreased in someone at risk for this condition.

avoid shellfish if you have goutThese foods include:

  • Shellfish, such as shrimp, lobster, and mussells
  • Protein from red meat, lamb, and pork and organ meats (like liver)
  • Gravy
  • Alcohol
  • Drinks and other food high in fruit sugar (orange, apple, and cranberry juice)


Drugs that can raise uric acid levels include:

  • Diuretics or pills to remove water from your body
  • Drugs that depress the immune system

Who Is At High Risk for Gout?

  • Men are three times more likely to have gout than women because they have naturally higher levels of uric acid.
  • Women after menopause - their uric acid levels start to increase.
  • Eating higher levels of foods rich in purines (see above).

people with diabetes and other chronic conditions are at higher risk for developing goutThose with the following health conditions:

  • Obesity or overweight
  • Congestive heart failure and high cholesterol
  • Diabetes
  • Kidney disease
  • Family history
  • High blood pressure

painful toesSymptoms of Gout

Most people with gout experience severe gout attacks. Here is common gout attack scenario. You wake up in the middle of the night with an acute throbbing pain in the big toe, which is also swollen. The pain lasts for around three or four hours and then subsides. However, pain in the same toe usually returns within a few months.

Other symptoms that can occur include:

  • Redness
  • Stiffness
  • Tenderness including a light touch
  • Warmth or the feeling of the joint being on fire.

Some people with gout have frequent flare ups while others can go without a flare up for years. However, if your gout goes untreated your flare ups will last longer and happen more often. Gout attacks can happen over and over to the same joint or can also occur in different joints.

How Does My Podiatrist Diagnose Gout?

Not all pain in your big toe or other foot joints is caused by gout. Pain in your big toe can also be caused by hallux rigidus or other foot conditions. Your podiatrist will need to evaluate you to determine if you have gout.

Your podiatrist will do some or all of the following to determine if you have gout:

  • Ask you about your symptoms - how often do your symptoms occur and how long do they last?
  • Conduct a physical examination – checking your joints for tenderness and warmth.
  • Run blood tests - these tests will assess the level of uric acid in your blood and other inflammatory markers.
  • Imaging - X-ray and/or ultrasound can determine how long you may have had the condition.
  • Needle aspiration - your podiatrist may pull fluid from your joint to examine for uric acid crystals to confirm gout.

Treatment of Gout in Seattle

Treatment of gout has two goals

  • Control your symptoms
  • Lower levels of uric acid in your body to prevent and reduce the chance of another attack

Medicine to control your gout symptoms include:

  • NSAIDs or non-steroidal anti-inflammatory medications such as Ibuprofen.
  • Colchicine – this drug must be taken within 24 hours of an attack to be helpful.
  • Steroids to relieve the pain and swelling.

In addition, you can increase your water intake, elevate your feet, put ice on your joints, and rest.

Drugs that lower uric acid levels in the body

These drugs are given to people that have frequent gout attacks, very high levels of uric acid in their blood, kidney stones, or a more advanced gout called tophaceous gout.

These drugs are:

  • Allopurinol
  • Febuxostat
  • Pegloticase
  • Probenecid

Prevention of Gout

Prevention of gout focuses on making behavioral changes.

It’s important to:

  • Drink plenty of water on a regular basis to flush out your kidneys and avoid becoming dehydrated
  • Reduce your weight to relieve pressure on joints and reduce inflammation and pain with gout. You can do this by:
    • Eating a healthy diet including lots of vegetables, fruits, and whole grains. Low fat dairy products, cherries, and unsweetened cherry juice may also decrease levels of uric acid.
    • Walking and other low impact exercises. Learn more in this article, “Walking and Exercising When You Have Gout”.
  • Limit the amount of foods and drink you eat which contain purines, the uric-acid building blocks. These are the exact same foods mentioned at the beginning of this article.
  • Limit or get substitutions for drugs that can increase your uric acid levels.
  • Remember to take your gout medications.
Dr. Rion Berg
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A podiatrist in North Seattle treating families for over 40 years.