Gout

What Is Gout?

Gout is a type of inflammatory arthritis that commonly affects the joints in the feet.  It is characterized by recurrent “attacks” of severe pain, where the joints become swollen, hot, red and extremely hypersensitive to touch.  These attacks are usually localized to one joint but may occur in multiple joints at once, and can make any activity involving the feet virtually impossible. 

Untreated gout attacks will often worsen.  The recurrent attacks of inflammation can ultimately damage the joints and surrounding tissue.

It is therefore very important to seek medical attention as soon as you suspect a gout attack – do not wait for it to reoccur.  Treatment by a doctor or foot specialist can help reduce the duration and frequency of gout attacks, provide pain relief and potentially prevent its recurrence.

Common signs and symptoms of gout affecting the feet are:

• Severe and sudden pain, swelling, redness and tenderness in the foot, usually at the 1st metatarsal phalangeal joint (big toe joint)
• Hypersensitivity at the affected area:  Even something lightly brushing against the affected surface, like a bedsheet, will cause pain.  
• Inability to move or do any activity involving the affected foot
• Lingering joint discomfort after attacks

The first attack of gout will typically only affect one joint (usually the MTP joint at the base of the big toe).  However, subsequent attacks may affect additional joints in the foot at the same time, i.e. other toe joints and the ankle may all experience the symptoms simultaneously.  

Gout attacks typically last for several days, with the first 24 to 36 hours being the most intense.  The time in between attacks may vary – it may be weeks, months or even years.  

If gout attacks continue to occur, residual effects may be felt in the affected joints between attacks.  The inflammation buildup from recurrent gout attacks may also cause joint damage and a variety of joint-related disorders (see osteoarthritis).

What Causes Gout?

Gout is caused by high levels of uric acid in the blood and tissues.  When uric acid levels in the bloodstream get too high, the body reacts by crystallizing the excess uric acid.  The crystallized uric acid then deposits itself in the joints. In response, the joints produce inflammation to defend itself from the uric acid crystals, which causes a flare-up of gouty arthritis (literally meaning gout-related joint inflammation). Uric acid crystals may also deposit themselves in the kidneys, which causes kidney stones.  

The following- usually in combination with each other – can cause high levels of uric acid and ultimately lead to gout:

• Diet: Foods that contain high amounts of a chemical called purine are known to raise uric acid levels.  Such foods include:
  • Red meat and organ meats (i.e.: liver)
  • Seafood:  anchovies, sardines, mussels, scallops, trout and tuna
  • Alcoholic beverages, especially beer (because of the yeast)
  • High-fructose beverages, such as artificially sweetened juices and pop
  • Yeast and yeast extracts

• Medical conditions:  Metabolic disorders that cause hyperuricemia (high levels of uric acid) can lead to gout. Such conditions include kidney diseases, leukemia, binge-drinking and eating disorders.  Diabetes may also possibly be associated with high levels of uric acid.
• Medications: Diuretics (commonly referred to as “water pills”), such as hydrochlorothiazide, can raise uric acid levels in the bloodstream and trigger gout.  Chemotherapy drugs, low-dose aspirin, niacin and beta-blockers are among some of the other medications that can potentially contribute to gout.
• Obesity or sudden weight gain: The body breaks down more purines (which produce uric acid) to manage the effects of obesity and weight fluctuations.  
• Genetic predisposition:  One may be genetically predisposed to conditions that cause high levels of uric acid to build up in the body.

How Is Gout Treated?

Gout is a type of inflammatory arthritis; therefore it is treated very similarly to rheumatoid arthritis.  Treatment usually entails preventative measures, pain relief, and dealing with any residual joint damage from attacks.  This involves a combination of the following:

• NSAIDs: Non-steroidal anti-inflammatory drugs are usually the first treatment prescribed for gout patients.  As the name implies, these drugs, which include Ibuprofen and Naproxen, reduce joint inflammation produced by gout.  
• Corticosteroids:  These are prescribed for gout patients who do not respond to NSAIDs or cannot take them (i.e.: heart patients).  Corticosteroids are also anti-inflammatories, however they have more side effects than NSAIDs.
• Medications that reduce uric acid levels:  These are typically prescribed in cases of recurrent attacks, and are often taken on a long term basis to prevent and/or reduce their frequency and intensity.
• Lifestyle modifications:  Diet, nutritional education and weight loss are effective at lowering the buildup of uric acid and inflammation in the body.  This includes:
  • Eating foods that contain less purines
  • Regular strengthening and exercise:  In addition to weight loss, strengthening and exercising our muscles and joints acts as a natural anti-inflammatory.  Physiotherapy exercises also address any joint damage caused by gout.
• Supportive footwear to deal with the effects of any gout-related joint damage:  This can alleviate joint pain between attacks, which can make it easier to do the other treatments required to manage gout (i.e.: physiotherapy, exercise, weight loss). 

A foot specialist can educate you about how you can reduce and deal with the impact of gout attacks.

A chiropodist can also assess your feet and gait, and address any gout-related joint damage in your feet.  This can involve custom orthotics or supportive footwear to reduce strain and counteract the arthritic effects of gout. 

For more information about treating arthritic conditions such as gout, see rheumatoid arthritis.

What Puts Me At Risk For Gout Attacks?

The following risk factors may increase your likelihood of getting gout or gout attacks:

• Gender:  It is estimated that about 90% of gout patients are male.  This is believed to be due to a metabolic predisposition men have for producing more uric acid.  
• Age:  Gout occurs most often in men over 40. Women affected by gout are typically post-menopausal.  
• Diets rich in purine:  Even though only an estimated 10% of cases are solely and directly caused by diet, a diet rich in purine in combination with other risk factors can make a person more vulnerable to gout.  It can also trigger subsequent gout attacks. 
• Alcoholism and binge-drinking:  Alcohol (especially beer) contains high levels of purines.
• Inactivity:  The effects of inactivity can lead to other risk factors that ultimately lead to gout, such as obesity, hypertension and diabetes. 
• Leukemia and certain cancers:  These can affect the metabolic processes that break down or produce uric acid.  In addition, some chemotherapy drugs used to treat cancer can make one more susceptible to gout.
• Diabetes:  The effects of Type 2 diabetes can make one more prone to gout attacks.
• Renal failure and kidney disease:  The kidneys are involved in the breakdown of uric acid. 
• Obesity and hyperlipidemia (high levels of fat in the blood):  These conditions cause the body to convert purine into uric acid.  Foods that are high in purines can  also cause weight gain and fat buildup.
• Hypertension:  Some of the drugs used to treat hypertension can raise uric acid levels.
• Dehydration:  The effects of dehydration can raise uric acid levels.
• Genetics:  Some people are genetically predisposed to the conditions and risk-factors associated with gout

How Can I Prevent Gout?

Gout is a complicated disease with many interplaying factors.  While some of these factors may not be preventable, there are many that we have some control over, or can at least mitigate.  There are also many things gout patients can do to help prevent future attacks.  Most of these preventative measures are good for us anyway, so it’s beneficial to follow them even if we’re not at risk for gout.

These include:

• A balanced diet: Good overall nutrition is good for us in any event.  To help prevent gout:
  • Avoid or reduce foods that are high in purines
  • Avoid or reduce foods that cause inflammation (you can check out this great article by Harvard Health for more information)
• Stay active: By keeping the muscles and joints in our feet and legs strong, they are better able to withstand the strain of our everyday activities, and therefore are less injury-prone. When our body is less injury-prone, it produces less inflammation. View our Pinterest page for infographics and video demonstrations of stretches and exercises you can try at home. 
• Maintain a healthy weight
• Stay hydrated
• Drink alcohol in moderation
• Avoid medications that can cause gout, like diuretics (water pills) if possible
• Address any biomechanical abnormalities or foot conditions:  A foot specialist can assess and treat your feet for any conditions that may cause or contribute to joint inflammation.

For patients that have had gout attacks, the following medications may be prescribed on a long term basis to prevent future attacks:

• Anti-inflammatories
• Medication to reduce uric acid production
• Medication to promote uric acid breakdown/expulsion

Since gout is a form of inflammatory arthritis, anything that can help prevent arthritis also helps with gout.  Click here for more information about inflammatory and rheumatoid arthritis.

Our chiropodists can help you find the solutions that work best for you to prevent gout attacks and gout-related joint damage.  Book your assessment today through our online booking form, or contact us at 416-769-FEET (3338).  Our clinic is open Mondays to Fridays from 9am to 6pm, and Saturdays from 9am to 4pm.