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Gout

What is it?

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, but can happen almost anywhere in the lower extremities (most common), as in the upper extremities (less common).

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 (DNA) 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 (i.e. – “under excreters” & “over producers”). Gout occurs most commonly in the big toe or the forefoot because uric acid is sensitive to temperature changes. At cooler temperatures, uric acid turns into crystals. Since this area 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 or area 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 marked by the following symptoms:

  • Intense pain that comes on suddenly – often in the middle of the night or upon arising (typical scenario is a bed sheet that causes intense pain just by touching the foot lightly).

     

  • 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

     

  • Dietary restrictions

     

  • Fluids

     

  • Immobilize and elevate the foot

The symptoms of gout and the inflammatory process usually resolve in three to ten days with treatment, and they may or may not be chronic for the patient. A thorough examination and follow up is often necessary to manage patients prone to gout attacks.