Gout is caused by an abnormal accumulation of uric acid in the blood stream. Uric acid is a substance that is produced by the breakdown of proteins in the body. It is usually excreted in the urine, but people with gout tend to have a decreased ability to remove the substance in this way. As the increased amount of uric acid builds up in the blood stream, a crystal form of the substance can begin to accumulate in certain joints in the body. These uric acid crystals have a tendency to accumulate in joints of the lower extremity, particularly the knee, ankle, and big toe joint. The body begins to mount an inflammatory response in an attempt to “break down” the crystals.
Gout is characterized by a painful, red, hot, and swollen joint. Many describe the pain as being so severe that even the bed sheets touching the foot can elicit extreme discomfort. Gout typically develops rather quickly without any history of trauma to the joint.
Factors that contribute to the onset of gout are excessive alcohol consumption, red meats and other foods, and certain medications. Heredity also plays a major role. The condition is much more common in men, but women often can develop gout after menopause or post-hysterectomy.
Gout is mainly diagnosed based on clinical symptoms. If the diagnosis is in question, however, blood tests can be done to check the uric acid level in the blood stream. Sometimes, it is also necessary for the doctor to take a sample of the joint fluid to be evaluated for uric acid crystals. This is the definitive test for gout.
If left untreated for long periods of time, a person can develop a chronic form of the disease called tophaceous gout. This occurs as the uric acid crystals continue to be deposited around the big toe joint. This can be a serious consequence of the disease as the joint cartilage can begin to be damaged often resulting in a painful and chronic arthritis.
What we can do to help you with this pain
If you are having pain and swelling in your foot that is typical of an acute gout flare-up, we would recommend that we see you in our office for treatment.
Initially, we will take a thorough history of the problem and perform a comprehensive physical examination of your feet to determine the exact diagnosis and the cause for your pain. We often will take digital x-rays to assess for any underlying bone or joint pathology as this too can help determine the diagnosis. It may be necessary to take blood work to assess the level of uric acid in your blood.
To help with an acute gout flare-up, it typically will be necessary to place you on an anti-inflammatory medication. There are various medications that can be used for this treatment, but medications such as Colchicine, Prednisone or Indomethacin are typically used. Sometimes, a nerve block can be very helpful in quickly relieving the pain from a gout flare.
It is important to treat the underlying cause of the gout flare-up, which is the elevation of the uric acid in the bloodstream. To treat this, it will be necessary to work with your family physician to find the right combination of long-term treatments. This may include altering current medications or utilizing various medications such as Allopurinol or Probenecid to help reduce the level of uric acid in your system.
The doctors at Council Bluffs Foot & Ankle Care are experts in the treatment of acute gouty flare-ups. We can help get you out of pain quickly and help you to manage this condition to prevent future flare-ups.