Gout is the world’s most common form of inflammatory arthritis, usually characterized by severe joint pain. This pain typically affects the big toe but can also affect other joints, such as the ankles, knees, wrists, and fingers.
According to the World Health Organization (WHO), gout affects an estimated 1-2% of adults in developed countries. However, incidence can be as high as 6% depending on location, and research suggests these rates have increased in recent years.
Gout is a curable rheumatic disease. Although when left untreated, gout can lead to more serious complications, including joint damage, kidney damage, and cardiovascular disease.
Gout results from a build-up of monosodium urate or MSU crystals in the joints. This buildup happens when the body produces too much uric acid or cannot eliminate it efficiently, causing sharp, needle-like crystals in the joints to form.
A healthy human body avoids this buildup by regulating the amount of uric acid in the blood. The kidneys filter uric acid and other waste products, disposing of them in urine.
However, the kidneys cannot keep up with the acid buildup in a person with gout. As a result, the concentration of uric acid exceeds its solubility limit, and the excess amount crystallizes in the joints as MSU.
The body’s immune system detects these sharp structures and responds with inflammation, causing pain.
Gout is most common in the feet, especially in the big toe or hallux. This trend is because the cooler temperatures at the extremities can make MSU crystal formation much more likely.
The hallux is the largest digit on our feet, which means it bears much of our body weight when walking. This excess strain makes the big toe very susceptible to inflammation in and of itself, and more so in cases of gout.
When you visit a podiatrist to treat gout, they will likely recommend a program to manage your symptoms and reduce the risk and severity of attacks. Here are several treatments your podiatrist may recommend when dealing with gout:
Some medications can help relieve pain and inflammation during an acute gout attack. Here is a list of medications typically used to treat gout and its symptoms.
As their category suggests, these drugs help relieve pain and inflammation. Examples include ibuprofen, naproxen, and indomethacin.
This medication is less preferred than NSAIDs; however, it can be recommended for people resistant to or who react adversely to NSAIDs.
This medication is used for chronic gout and reduces the amount of uric acid produced in the body. It is often used for patients with frequent gout attacks or developing tophi.
Febuxostat is a drug used for patients with hypersensitivity to Allopurinol. It is considered more effective than standard doses of Allopurinol, though it is also far more expensive.
Note that many of these medications require prescriptions and the advice of a medical professional. These medications may not be appropriate for everyone, and treatment should be tailored to each individual’s specific needs and medical history.
A good podiatrist may suggest several lifestyle changes that can help manage gout symptoms. Often, the first significant changes to be made will involve your diet.
Purine-rich foods, such as red meat, shellfish, and alcohol, can increase uric acid levels and should be avoided. On the other hand, increased intake of low-fat dairy products has been shown to reduce the risk of gout.
Increasing water intake can lower uric acid concentrations in the blood and make it easier for the kidneys to filter waste. Conversely, substances such as nicotine and alcohol can increase uric acid levels and, thus, should be avoided.
Dietary and health information such as this can help a health practitioner plan a program specific to you.
Your podiatrist may recommend various exercises and stretches to promote joint health and mobility, alleviate gout symptoms, and prevent joint damage. They may also suggest wearing proper footwear and orthotics (custom-made shoe inserts) to support the feet and improve gait.
You usually want to engage in range-of-motion and strengthening exercises when dealing with gout. The former includes simple stretches to maintain smooth movement in your joints, and the latter builds the muscles and tendons that support your joints.
You can engage in exercises with minimal to no equipment as well. Low-impact exercises such as swimming, biking, or walking can help improve cardiovascular health and flexibility without putting too much pressure on the joints.
Resting the affected joint is important to allow it to heal properly. Resting the joint can also prevent further damage, supplementing the strength built by healthy exercise.
Orthotics are made using a mold or scan of the patient’s foot, which is used to create a custom-fit insert that fits snugly into their shoe. The insert is designed to correct any imbalances or abnormalities in the patient’s gait, providing cushioning and support.
There are two main types of orthotics: accommodative and functional. Accommodative orthotics are designed to provide cushioning and support for the feet, while functional orthotics are designed to improve the function of the feet and lower limbs.
In addition to these, your podiatrist may also recommend physical therapy or massage to help improve joint function. Following your podiatrist’s recommendations for joint care is important to help manage your gout symptoms and prevent future attacks.
A corticosteroid injection is a medical procedure where a healthcare provider injects synthetic hormones into a specific body part. These injections commonly treat various inflammatory conditions, including arthritis or tendonitis.
The hormones injected, called corticosteroids, are similar to the natural hormones the adrenal gland produces and have powerful anti-inflammatory properties. Patients may also take them orally, but injections provide direct access to the joint.
In the case of gout, the procedure is performed on the affected joint to reduce inflammation and relieve pain. The injection typically includes a numbing agent to provide immediate pain relief.
Surgery is not a common gout treatment, but it may be considered in rare cases where other treatments have failed or if joint damage requires surgical intervention. It is usually reserved as a last resort for severe cases of chronic tophaceous gout.
Chronic tophaceous gout is a severe form of gout that can occur when the disease has been left untreated or undertreated for an extended period. It is characterized by large, visible deposits of urate crystals called tophi.
Tophi are usually painless but can cause complications if they become infected or rupture. Chronic tophaceous gout can also lead to joint damage, nerve compression, and kidney damage.
Surgical solutions range from tophi removal to – worst case scenario – synovectomy. During a synovectomy, the surgeon removes the inflamed synovial tissue that lines the affected joint.
A synovectomy can help relieve pain and improve joint function by removing inflamed synovial tissue and reducing the production of urate crystals. However, it is not a cure, and you must still manage the underlying causes of gout to prevent further attacks and joint damage.
It’s important to remember that while gout treatment is generally the same across cases, the severity of symptoms and, thus, individual needs differ. Dr. Elizabeth Auger will work with you to determine the best course of treatment for your case.
Dr. Auger helps patients in Salt Lake City who suffer from gout. Visit one of our three convenient office locations in West Jordan, Millcreek, and Sandy.
Call (801) 619-2170 today and make a same-day appointment to get the help you need from a skilled foot doctor.