Gout is most commonly known as a disorder of the first metatarsal phalangeal joint of the foot. In other words, the base of the big toe where you would find another problem known as a “Bunion”.
Gout is not however a bunion (though often mistaken as such) A bunion is related to osteoarthritis and attributed to wear and tear whereas gout is a metabolic problem. This means that the body is having difficulty in metabolising what is being ingested resulting in high levels of uric acid in the blood which then turns into microscopic crystals.
Uric acid is a salt made up from carbon, nitrogen, oxygen and hydrogen also known as Ammonium Acid Urate and is created when the body breaks down chemicals called purines and which is expelled from the body when having a pee.
The problem is that some people have difficulty in metabolising the urate such that it cannot be excreted and so it collects in some joints, particularly the big toe, elbow and knee.
Gout is more common in men over the age of 40 years with 90% suffering initial symptoms in the big toe.
Signs and Symptoms
In it´s acute phase, a gouty toe will become swollen and red and extremely tender. The pain comes on quickly and can appear to be worse at night. The skin around the toe is inflamed and appears tight and shiny.
The sufferer will find shoeware uncomfortable and there may be pain when walkng..
An acute attack can last anything from days to weeks if not treated. Even after the symptoms have subsided there is a chance of recurrance with attacks getting more frequent and possibly spreading to other joints.
Foods which are high in purines can increase the level of uric acid in the blood such as red meats, offal (kidney, liver and heart) and shellfish. Large quantities of beer, spirits and fortified wines such as port and sherry are also known to raise the level.
Some medical conditions will predispose a risk of gout, particularly those affecting the filtration ability of the kidneys for example; kidney disease, diabetes, hyperthyroidism, obesity, high cholesteral, psoriasis …
Some medications are known to increase the risk of gout such as chemotherapy agents, diuretics, beta blockers, low dose aspirin and niacin.
Initially the problem will be managed medically to end recent acute attacks and also to prevent further attacks. This is commonly done using non steroidal antinflammatories, Colchicine and intra-articular cortisone injection. The Doctor will also look toward reducing the high uric acid level in the blood which is done through medication and diet. Allopurinol (aka Zyloprim) may be prescribed, avoiding foods high in purine, reducing carbohydrate intake and increasing water intake.
While the primary treatment for gout is medical, physiotherapy may be suggested to help reduce the painful swelling using cryotherapy and also for gait assessment and to provide splinting or orthotics to protect the painful joint.
Important Note; If you suspect that you may be suffering from gout you should avoid any medication containing aspirin.