You slip into bed at night, only to be woken hours later by a burning pain so terrible, even the weight of the sheets on your foot feels unbearable! When you look down, your big toe is red and swollen. And you’re wondering: what’s causing this pain in my big toe, and how can I get rid of it?
In my Houston podiatry practice, when patients come in complaining with this kind of sudden pain in their big toe joint, I most often diagnose them with gout.
Luckily, we can offer quick relief for the burning pain of gout. Then, we can recommend lifestyle changes that can help prevent future flare ups. But we’ll need your cooperation, because gout flares are often triggered by poor dietary choices. So, to help keep the burning pain of gout at bay, keep reading for more information about this painful form of arthritis. And call our office for an immediate appointment if your big toe feels like it’s on fire. Because we can often offer same-day emergency appointments, and get you pain relief faster than you might imagine!
What is Gout?
The burning pain of gout comes in sudden flares. But that swollen red toe is actually a symptom of a common (and complicated) form of arthritis. Gout flares pop up when uric acid levels build up in your blood, causing uric crystals to form. Those crystals then build up around your joints, causing inflammation and excruciating pain.
Most often, the first symptoms of gout develop around your big toe joint. That’s why, as your podiatrist, I’m often the one to deliver your gout diagnosis. But gout flares can cause joint pain other places in your body, which is why it’s important to watch for and talk about any type of sudden joint pain with your doctor.
Symptoms of Gout
People often ask, “How do I know if it’s gout?” And I usually answer, “You’ll just know.” That’s because gout pain in your big toe is so intense, it’s almost unmistakable. Aside from burning pain in your big toe, gout symptoms include:
Intense pain in other joints
As I said, gout usually goes for your big toe joint first. But gout attacks are also common in your ankles, knees, elbows, wrists and fingers. And that pain will be most severe in the first four to 12 hours after onset.
If you don’t seek immediate treatment, you can expect to notice lingering pain in your joints. It could take anywhere from days to weeks to completely go away. And, the more gout flares you experience, the longer it takes for pain to go away.
Redness and inflammation
When gout hits your big toe joint, the whole toe can become swollen. It will also be tender and warm to the touch, and the skin may look red.
Limits on movement
If allowed to progress, a gout attack can impact the range of motion on your toe joint.
What Causes Gout?
As I mentioned earlier, gout flares develop when uric acid becomes more concentrated in your blood. But several factors can contribute to that build up, so we’ll look at each gout risk factor on its own.
A High Protein Diet
Your body produces uric acid when it has to break down proteins into purines. Now, purines on their own aren’t harmful. But when you eat foods with extremely high purine concentrations, you may get into trouble. Some of the worst gout trigger foods have the highest purine levels. These include organ meats such as liver, red meats such as steak, and many types of sea food.
Some beverages are also to blame. Alcohol—especially beer, and sweet juices packed with fructose are risky choices when it comes to gout. Alcohol is dehydrating. When your body is dehydrated, it will increase the concentration of uric acid. As a result, I often see gout patients right after the Super Bowl or Thanksgiving, as these are days we tend to indulge in dehydrating treats.
Since gout flares happen when uric acid is more concentrated in your blood, dehydration is also a risk factor. Why is that the case? Even if your diet is healthy, small levels of uric acid can become a problem if you’re dehydrated. Because, with less fluid in your body, it’s harder to dilute even a little bit of uric acid. So crystals may build up and attack your joints, leaving you with painful gout symptoms.
Weight and Medical Conditions
If you’re carrying extra weight, your gout risk is higher. This is because your body starts to produce more uric acid. Plus, your kidneys can’t do as good a job of filtering the acid through your urine. So concentrations can build up quickly.
Some medications can also trigger out flares. So, if you’re taking diuretics, hypertension medications or even a daily low-dose aspirin supplement, talk to us about how you can prevent gout flares.
Genetics and Age
If you have a family history of gout, you’re at higher risk for this form of arthritis. Also, men are more likely to get gout than women. Especially when they’re between the ages of 30-50. But remember, after menopause, women’s feet are at a higher risk for gout flares. Because, at that point, their bodies make almost as much uric acid as men’s do.
Injuries and Surgery
As with all forms of arthritis, your body is more vulnerable to gout attacks after an injury or surgery. So, if you’ve been in our office recently for a broken toe, or if you’ve had recent foot surgery, we’ll talk to you about preventing gout attacks. Particularly if you have a family history or additional risk factors.
Often, I can diagnose gout with a clinical exam. I often joke that the symptoms are so severe, I don't even have to walk into the room to diagnose gout! But I may also draw fluid from your big toe joint in order to look for urate crystals under the microscope. (This is called a joint fluid test.) Additionally, I may order blood tests to test for uric acid levels. In some cases, we may need to take x-rays to rule out injuries or other sources of inflammation.
Non-Surgical Treatment for Gout
We usually treat gout with medications—both during a gout flare, and afterwards to prevent future incidents.
Medications for Gout Pain
When you’re experiencing a gout attack, I’ll prescribe one of three main types of medication. The prescription you receive will depend on the severity of your symptoms. Medications we use to relieve gout pain include over the counter non-steroidal anti-inflammatories (NSAIDS, such as Advil or Motrin), or prescription NSAIDs such as Indocin. I may also prescribe Colchicine, a medication that specifically reduces gout pain. But it can cause unwanted side-effects, so it may not be my first choice. Finally, I may recommend a steroid pill or injection to quickly reduce your gout pain and inflammation.
Medications to Prevent Gout Flares
Once your acute gout pain clears up, we can discuss preventative gout medication. I would certainly consider this kind of prescription if you have more than two gout attacks each year. Medications that prevent your body from producing uric acid, such as allopurinol, can be helpful. Or, you may need medications such as Allopurinol or Uloric that help your body filter out uric acid.
Lifestyle Treatments for Gout
Many people can prevent gout attacks with simple lifestyle changes. You can limit your alcohol and juice intake, drink lots of water, and avoid the purine-rich foods I already mentioned. It’s also important to maintain a healthy weight to avoid gout. So, if you’re carrying extra pounds, let
’s talk about a safe weight-care program. And, regardless of your weight, make sure to get regular exercise. This will go a long way to preventing gout attacks, while improving your general health as well!
Come in for Gout Treatment and Prevention
The next time your big toe starts throbbing, you’ll know who to call. Reach out to our Houston podiatrist right away for an appointment. We can help relieve your pain quickly and effectively.
But we also hope you come in to discuss gout before you get a painful wake up call. So, if you have a history of gout attacks, or recognized some of the risk factors in your life, come in now before you see a problem. That way, we can work together to protect your joints from the awful arthritis pain of gout!