Does Gout Affect Your Feet – If you experience joint pain and swelling, it could be gout. Here’s how to recognize the symptoms of gout versus other causes of pain and ways to start treatment early to prevent joint damage.
Louise B. had a flare-up of gout in the lower joint of her right big toe, a common joint for gout.
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Does Gout Affect Your Feet
It starts with a tingling sensation and some swelling and quickly becomes extremely painful, very swollen and red. “This pain is off the charts, absolutely excruciating,” she shared in response to a recent Facebook post where people asked what gout pain was.
Why Does My Big Toe Hurt Suddenly?
When Ross W. got his first bout of gout on a singles ski trip a few years ago, he thought he broke his big toe. He spent the weekend with a limp — unable to hit the slopes — and saw a podiatrist upon his return. Ken L., in his sixties, began experiencing leg pain as a teenager, which he attributed to street hockey. But when he started having trouble walking or even putting his foot in a shoe, he realized it was more than just an injury.
In other patients, gout attacks tend to strike the backs of the fingers and feet. Soledad B., for example, shared that she developed gout in her elbows.
According to recent data, gout is the most common type of inflammatory arthritis, affecting more than 9 million adults in the United States. Gout is a condition that develops when the body has high levels of uric acid, a normal waste product. Uric acid is normally removed from the body through the kidneys, but in some people, levels can remain high and uric acid can begin to accumulate and crystallize in various joints. This is what triggers a gout attack.
“A gout attack is usually subtle,” says John D. FitzGerald, MD, PhD, a rheumatologist and internationally recognized expert at the David Geffen School of Medicine at UCLA Medical Center in Los Angeles.
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Unlike other types of arthritis, which can cause fairly dull, aching chronic pain and stiffness, a gout attack comes on quickly. Dr. FitzGerald describes a gout flare-up as sudden and very painful in a joint, often at the base of the first big toe, but advises that gout can affect almost any other joint, which can make it difficult to recognize.
Depending on which joint is inflamed with gout, the pain and impact of the inflammation can cause different problems. Here’s a list of joints prone to gout flare-ups and how the pain can affect you, according to the Hospital for Special Surgery.
Gout can develop hard deposits of uric acid called tophi. These deposits grow under the skin around cartilage, such as above the ear and around the joints, and can be diagnosed as chronic tophaceous gout, according to the Johns Hopkins Arthritis Center.
If gout flare-ups continue without treatment, permanent damage to the joint can occur, leading to impaired movement.
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Imagine a collection of shards of glass sticking out like needles. This is how it feels when a gout attack causes a build-up of uric acid in the blood (called hyperuricemia) to form microscopic crystals that grow in and around the joint. As the aggregate increases, the immune system reacts to these crystals and causes inflammation that causes visible swelling, redness, and debilitating pain.
In some cases, a gout flare-up can even cause a fever and look like an infected joint, Dr. FitzGerald. “The attending physician may need to look for a possible source of infection by removing fluid from the joint frequently to send it to a laboratory to look for crystals or bacteria.”
Uric acid is a byproduct of the body breaking down proteins called purines from its own cells and from certain foods, such as red meat and shellfish. Alcohol and drinks sweetened with high fructose corn syrup are also high in purines. Normally, uric acid dissolves in your blood and is filtered out by your kidneys, but when your body produces too much uric acid, or if your kidneys can’t filter it either because of family (genetic) causes or kidney disease, then uric acid builds up. It forms needle-like urate crystals that cause gout and can also form kidney stones, according to the Mayo Clinic.
According to the US Centers for Disease Control and Prevention, certain factors make some people more likely to develop gout. Risk factors for gout include:
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“Typically, gout pain comes on quickly and the joint becomes red and swollen, with swelling peaking within the first 24 hours after the attack,” says Dr. FitzGerald.
At first, gout usually affects only one joint, but it can affect more than one joint, sometimes adjacent joints. Flares usually go away on their own within the next 7-14 days. Treating a gout flare with medication can help it resolve more quickly. Medicines for gout flares usually include:
A gout attack can occur once or twice a year, or even several times. However, gout can become chronic, causing frequent attacks and flare-ups that occur at least a few times a year, or never completely disappear. Chronic gout can damage and deform the joints and can sometimes be mistaken for other inflammatory diseases such as rheumatoid arthritis.
If you experience sharp, sudden pain in one or more joints, the pain is so debilitating that it is difficult to walk or put on shoes, and you have risk factors for gout (especially a family history), there is good reason to suspect gout. guilty. However, it is important to consult a doctor for a thorough examination and correct diagnosis.
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Dr. FitzGerald warns that problems unrelated to gout can lead to an irritated, inflamed joint. Gout can be confused with a number of other conditions that can cause similar symptoms, including:
Pseudogout (the technical term for calcium pyrophosphate dihydrate storage disease) is caused by another type of crystal, calcium pyrophosphate. A pseudogout flare-up is similar to gout, but it affects more of the wrist and knee and is less likely to involve the big toe. Like gout, pseudogout is considered a form of inflammatory arthritis. According to the Cleveland Clinic, it is more likely to affect people over age 40 and those with thyroid disease, kidney failure, or a disorder that affects calcium, phosphate, or iron metabolism.
It is possible to have gout without the classic symptoms of red, hot, sharp, burning, sudden pain in the big toe, foot, ankle, or knee. Some patients may have joint pain that is less severe.
The good news is that there are effective medications for treating gout, Dr. FitzGerald. In some mild cases, gout can be managed with lifestyle changes, such as losing weight as needed and eating less foods high in purines (alcohol, sugar-sweetened beverages, red meat, and seafood).
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However, many people with gout need to take preventive medications to lower uric acid levels and stop flare-ups. According to the American College of Rheumatology’s 2020 gout treatment guidelines, uric acid-lowering medications are recommended for people who:
Guidelines co-author Dr. FitzGerald recommends a “target-by-target” strategy, which involves treating gout with medication until a target uric acid level is reached.
Unfortunately, gaps in the quality of gout care persist, and many patients do not take medications to lower uric acid levels, which can relieve people of intense and persistent gout pain. That’s why it’s important to see a doctor if you’re experiencing pain that you think might be gout, Dr. FitzGerald.
Anti-inflammatory drugs (NSAIDs, colchicine, and glucocorticoids) are used to relieve pain during gout flare-ups, while various medications are used to reduce uric acid levels to prevent future attacks. These include:
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Another drug called pegloticase (Krystexxa) may be recommended for people with chronic gout who do not respond to other uric acid-lowering medications.
Although many people with gout can be treated by a primary care physician, if the gout does not respond to medication or worsens or flares up frequently, or if tophi gout lesions develop, then the primary care physician may refer you to a specialist rheumatologist. in the treatment of disease affecting the joints, muscles, bones and immune system.
Taking medication to lower uric acid levels and reduce the risk of developing gout is important, Dr. FitzGerald. “If you have risk factors for bad gout, such as kidney disease, or if you experience frequent attacks, early treatment is better.”
Check out PainSpot, our pain localization tool. Answer a few simple questions about what hurts and identify possible conditions that could be causing it. Take your PainSpot quiz.
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Chen-Xu M et al. Current prevalence and decadal trends of gout and hyperuricemia in the United States: National Health and Nutrition Examination Survey, 2007–2016. Arthritis and Rheumatology. January 2019. doi: https://doi.org/10.1002/art.40807.
FitzGerald and others. 2020 American College of Rheumatology Guidelines for the Management of Gout. Arthritis Care and Research. June 2020. Doi: https://doi.org/10.1002/art.41247.
Interview with John D. FitzGerald, MD, PhD, rheumatologist and internationally recognized gout expert
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