Gout and foot pain


Gout is a form of inflammatory arthritis characterized by a sudden and severe onset of pain, swelling, tenderness, and redness.

In ancient times it was sometimes referred to as the “disease of kings” because people wrongly associated it with overindulging in food and wine that only the wealthy could afford.

The most common place gout occurs is at the base of the big toe in a condition known as podagra. Gout also frequently affects joints in the ankle, other parts of the foot, knee, hands, wrists, or elbow.

Typically, only one joint at a time is affected, but when gout is more severe or ongoing, it can also involve several joints at the same time.

Gout symptoms come and go, often with long periods between onsets. When those symptoms get worse, it is known as a flare-up or an acute attack. When there are no symptoms, this is known as remission. Men are affected by gout three times as often as women. It is also more common in men over 40 and women after menopause.

Chronic gout attacks can lead to a worsening form of arthritis known as gouty arthritis.

In some cases, gout is an inherited condition. This means gout tends to run in families as it is passed from one generation to the next. Gout also frequently occurs when other medical problems are present, including metabolic syndrome, hypertension, insulin resistance, lead poisoning, hemolytic anemia, solid organ transplants, and a body mass index greater than 35.

Though the medical evidence isn’t completely clear, researchers believe that specific genes, such as SLC2A9, ABCG2, and others, make it easier for diet and other environmental and lifestyle factors to trigger bouts of gout. These genes affect the amount of uric acid the body holds onto and releases, which is a direct cause of gout flares.

Although there is no cure, there are several ways to treat the condition and prevent flares. Modifications in diet and lifestyle and medications that reduce the amount of uric acid can control many of the painful aspects of gout.

Failure to seek treatment can result in irreparable joint damage and other complications. This is because the build-up of uric acid crystals can produce hard deposits called tophi. The tophi appear as small knots and can damage bones and cartilage, leaving joints permanently deformed.

Gout, Uric Acid, and Kidneys

Gout is caused by too much uric acid that builds up in the bloodstream, causing urate crystals to form in body tissues. When these deposits build up in joints, it produces swelling, pain, and inflammation.

An elevated blood uric acid level is referred to as hyperuricemia. Hyperuricemia doesn’t always cause gout, and if gout symptoms aren’t present (known as asymptomatic gout), it doesn’t need to be treated.

Uric acid is produced as a byproduct of the way the body breaks down proteins called purines. Purines are important to a person’s health because they serve as building blocks for DNA. They are naturally present in all foods in varying amounts. For example, foods that contain a higher uric acid level include red meat, alcoholic beverages, and drinks sweetened with fructose.

Researchers have discovered that purines play a vital role in cardiovascular systems’ health, impacting blood flow and oxygen delivery. Purines are essential to the digestive system, playing a pivotal role in fluid secretion and food movement as it is digested.

Kidney disease, thyroid problems, obesity, or an inherited condition can make it more difficult for a person’s body to remove excess uric acid, potentially leading to gout.

Usually, uric acid dissolves in blood and passes through the kidneys before being expelled in urine. When a body produces too much uric acid or the kidneys can’t excrete enough uric acid, a build-up occurs. Sharp, needle-like urate crystals form in a joint or surrounding tissue, producing gout symptoms.

In some cases, uric acid can also impact kidneys. This can produce uric acid kidney stones and reduced kidney function. Most kidney stones contain excess calcium, but uric acid kidney stones, while just as painful, are much less common, comprising only about 5% of all kidney stones.

Gout Signs and Symptoms

Gout signs and symptoms can flare up within a matter of hours. Often these symptoms will appear at night.

They can include:

Intense pain. About 50% of all gout cases start in the large joint of the big toe (the first metatarsophalangeal joint) but can occur in any joint in the body. Other common spots for gout flares include ankles, feet, knees, elbows, wrists, and fingers.

Joint pain is most severe at the initial onset, with the highest intensity lasting anywhere from 4 to 12 hours.

Initial gout attacks may only affect a single joint, but subsequent episodes are more likely to last longer and involve multiple body locations.

Ongoing discomfort. Even after the initial pain subsides, lingering pain is likely to exist for anywhere from three to ten days.

Redness and inflammation. The affected joint will become swollen due to a build-up of fluids as the body fights the condition. This is known as joint effusion. The impacted area will be tender, warm, red, and highly sensitive to even a light touch.

A fever combined with an inflamed and hot joint may be an indication of an infection. If this is the case, seek medical attention immediately.

The body’s natural defenses will attack the uric crystals, causing the release of chemicals called cytokines, and this reaction creates painful inflammation.

Limited range of motion. The ongoing impacts of gout may produce a limited range of motion in joints affected by the condition. Normal movement may be restricted.

The presence of tophi. A tophus is a hard nodule of a uric acid deposit found in various parts of the body, commonly on elbows, upper ear cartilage, and on the surface near joints. When tophi are present, there is a high amount of uric acid in the blood, which has developed over many years.

Kidney stones. In some cases, uric acid crystals form in the kidneys to produce kidney stones.

Pain and swelling are the results of the body releasing chemicals called cytokines. The immune system attempts to defend against the uric acid crystals, and the resulting battle creates these signs and symptoms.

Diagnosing Gout

There are several clinical ways to diagnose gout. A primary care physician or specialists such as a rheumatologist, orthopedist, or physical therapist will look at your medical history, current symptoms, and may perform or order one or more of the following tests listed below.

The easiest and most common way is through a joint fluid test (arthrocentesis). A doctor will use a needle to withdraw fluid from the affected joint and then examine it under a microscope. If gout is present, urate crystals may be visible.

Your doctor may also order a blood test. This will measure the urate levels and creatinine levels in your blood.

The drawback of blood tests is that they can be misleading. Some people may have gout signs and symptoms but will have normal uric acid levels in their blood. In other cases, some people may have high levels of uric acid but won’t develop gout.

Ultrasounds are sometimes administered to see if urate crystals are present in a joint or a tophus.

A doctor may also recommend a joint x-ray as a way of ruling out other possible causes of joint inflammation.

In rare cases, a dual-energy computerized tomography (CT) scan may be performed. This detects urate crystals in a joint, even when there is no acute inflammation. This test is not generally used because it is not widely available, and it is expensive to administer.

As part of a gout diagnosis, clinicians will also consider several risk factors that increase the likelihood of this condition, including:

  • Middle-aged male
  • Post-menopausal woman
  • Obesity
  • High blood pressure
  • A purine-rich diet (i.e., red meat and some kinds of seafood such as anchovies, sardines, mussels, scallops, trout, and tuna)
  • Consuming food and drinks high in fructose
  • Drinking alcohol (more than 12 drinks per week)
  • Physical trauma and surgery
  • Post-surgery complications
  • Sleep apnea
  • Family members with gout (inherited genes)
  • Dehydration
  • Medications that raise levels of uric acid in the bloodstream (i.e., diuretics, cyclosporine)
  • Some medicines that lower uric acid in the bloodstream can also initially cause a gout flare (i.e., Zyloprim, Aloprim)
  • Medications that lower blood pressure, such as beta-blockers and angiotensin II receptor blockers, can cause an increase in uric acid in the bloodstream
  • Low dose aspirin
  • Some types of cancer because high levels of uric acid are released when cancer cells are destroyed
  • Certain health conditions such as congestive heart failure, hypertension, insulin resistance, metabolic syndrome, diabetes, and poor kidney function

What To Do If You Have a Gout Attack

To minimize discomfort due to gout pain and swelling, it’s essential to take several steps immediately.

First, call a doctor and make an appointment. Your doctor will be able to make an accurate diagnosis and prescribe medications to ease your symptoms.

Until your doctor can see you, drink a lot of fluids, preferably water, and avoid alcohol and sweet sodas. If possible, elevate the joint and if you can tolerate it, apply ice to try and reduce some of the swelling. You can also take medication to help relieve some of the pain and swelling.

Take whatever steps you can to reduce stress and anxiety. Worry only makes gout worse. Get help from friends and family as needed so you can stay off your feet and reduce stress on your joints.

Treating Gout

There are several medications a doctor can prescribe during the onset of a gout flare. These include:

NSAID - A Nonsteroidal anti inflammatory drug such as aspirin (Bufferin), ibuprofen (Advil, Motrin), and naproxen (Aleve) is frequently used to relieve gout swelling and pain. If taken within the first 24 hours, they can reduce the overall duration of a gout attack.

Colchicine - This is another anti-inflammatory medicine that works best if administered within the first 24 hours of a gout flare.

Corticosteroids – Administered either orally or through an injection, will also provide quick relief from swelling and pain, working within 24 hours after taking.

After flares are treated, a nephrologist may prescribe medications that lower uric acid in the bloodstream over time. These drugs will either prevent or lessen the severity of future gout attacks and may include:

  • Allopurinol (Zyloprim) reduces the amount of uric acid the body produces.
  • Febuxostat (Uloric) reduces the amount of uric acid the body produces.
  • Probenecid helps kidneys eliminate uric acid from the body.
  • Pegloticase (Krystexxa) is used when medications are ineffective in lowering the body’s uric acid level. It is administered every two weeks by intravenous infusion.

Some side effects such as rashes, diarrhea, or nausea may occur, so check with your doctor to understand what these might be if you are prescribed any of these.

Research is also taking place on drugs to block gout flares when they don’t respond to other treatments. The goal is to block a chemical signal called interleukin-1 by using the drugs anakinra (Kineret) and canakinumab (Ilaris).

From a lifestyle perspective, you can control gout by modifying your diet and lifestyle. Begin an exercise program that includes weight reducing activities, which can be a simple as walking in comfortable shoes several times a week.

You should also limit or end your alcohol intake, avoid foods rich in purines, and work with your doctor to find compatible medications that don’t aggravate gout symptoms.

Gout Complications

Aside from extreme pain and swelling associated with the onset of gout, there are other long-term health implications to be aware of as well.

While some people rarely experience repeat flares of gout, others who have recurrent gout several times a year are in greater jeopardy of developing permanent damage and destruction of the affected joint. This is why seeking immediate treatment is crucial, aside from fast relief for acute pain and swelling.

Untreated gout may also result in urate crystal deposits that form under the skin. These nodules called tophi can develop throughout the body, such as in fingers, hands, feet, elbows, and Achilles' tendon. Typically, they aren’t painful, but they are unsightly. However, during an active gout flare, they can become more tender and swollen.

In extreme gout cases, gout surgery may be a viable option after repeated flares for many years.

Infections, joint damage, and torn tendons may require the surgical removal of tophi, joint fusion, or joint replacement surgery.

Pain Management and Natural Remedies

In addition to prescription medications, you can also do several things to manage gout on your own, which might include some lifestyle changes.

Studies have shown that certain natural remedies may lower uric acid levels to prevent gout flares. These include:

  • tart cherries
  • magnesium
  • ginger
  • apple cider vinegar
  • celery
  • nettle tea
  • dandelion
  • milk thistle seeds

Essential oils have also been touted as a remedy for gout due to their anti-inflammatory and pain-reducing effects. You can rub diluted oils on your skin or breathe them in. If you follow this course of treatment, it’s always best to check with a doctor first. Also, essential oils are not safe to ingest directly.

Essential oils used to treat gout include:

  • lemongrass oil
  • celery seed oil
  • yarrow oil extract
  • olive leaf extract
  • Chinese cinnamon

The CDC also recommends five self-management strategies for treating arthritis of all kinds.

Besides losing weight, eating a healthy diet, protecting your joints, and learning self-management skills, you should also get physically active.

You should engage in at least 150 minutes of activity weekly. Moderate low impact activities like walking, biking, or swimming are ideal.

You’ll need a good pair of comfortable shoes, and as you might guess, we think Kuru is your best choice when it comes to comfort, durability, style, and price.

Kuru focuses on innovative shoes designed to maximize comfort for a pain-free experience. Kuru’s patented KURUSOLE guarantees a healthier stride by dynamically flexing with every step. While other shoes flatten the fat pad in your heels, Kuru places your fat pad exactly where nature wants it and creates a natural cushion as nature intended.

As you know by now, gout is excruciating. You’ve got to do everything you can to minimize that pain while your body heals. We think Kuru is the perfect choice for men and women to relieve gout pain that flares up in your toes, ankles, feet, and lower extremities.

And we’re not alone in those sentiments. Kuru is overwhelmingly recommended by medical professionals to reduce and minimize foot pain.

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