GOUT: BIG TOE PAIN - CAUSES, DIAGNOSIS, HOME REMEDIES, AND MORE
Gout is a form of joint inflammation (arthritis) that causes sudden, excruciating pain in one of your joints - most frequently the big toe.
It’s a result of high uric acid levels in your blood, which can happen with an unbalanced diet and certain unhealthy habits. Gout is considered a chronic disease that causes joint inflammation and pain every now and then - “gout attacks”.
There are many medical treatments and home remedies to deal with gout flare-ups and relieve pain. For those who have frequent attacks, chronic medications may be prescribed. Dietary and lifestyle changes are essential to prevent gout attacks and control your uric acid levels.
Keep reading to learn more about gout, how it’s diagnosed, and ways to treat it!
WHAT IS GOUT?
Gout is regarded as a chronic condition, meaning that it has no definite treatment. It is an inflammatory joint disease (arthritis), where one or more joints occasionally become inflamed and painful for a few days. When this happens, it’s called a gout attack.
Gout is the most common form of inflammatory joint disease. Men are three times more likely than women to develop it.
According to this article in Nature Reviews, gout affects around 3.9% of the population in the United States. This varies from one region to another depending on different dietary and lifestyle habits.
SYMPTOMS
Gout attacks usually affect one joint at a time, and it’s usually the big toe. Other joints that are frequently affected by gout include the ankle, knee, elbow, and wrist.
During a gout attack, the affected joint can manifest any one or more of these symptoms:
- Sudden severe pain
- Redness
- Swelling
- Tenderness to touch
- Stiffness and limited range of motion
A gout attack usually lasts around a week, and then the symptoms improve gradually. If attacks are treated properly without long delays, long-term joint damage can be avoided.
CAUSES
Gout is caused by hyperuricemia, which is a medical term that means high uric acid blood levels.
Uric acid forms in your blood as a result of the breaking down of purines; chemical compounds found in body cells and meaty foods you consume.
Having a high level of uric acid does not always cause problems. However, when uric acid molecules crystallize, the microscopic sharp crystals can accumulate in joints and cause them to become inflamed; a gout attack. You can imagine the crystals as microscopic needles entering your joint and damaging it.
The reason why gout most commonly affects the big toe is that uric acid crystals usually form at lower temperatures. Since the big toe is the farthest body part from the heart, it is also usually the coldest body part.
RISK FACTORS
Doctors have been able to identify several risk factors that make you more likely to develop gout. These are mostly related to diet and lifestyle. The identified gout risk factors include:
- Male gender
- Women after menopause (same risk as men)
- Obesity or being overweight
- Taking certain diuretics
- Certain medical conditions (Heart failure, hypertension, diabetes, kidney disease)
- Overconsumption of alcohol
- Drinking or eating foods very rich in sugar (especially fructose)
- Eating a lot of meaty foods and foods rich in purines (see them below)
- Genetics
Gout comes in the form of flare-ups or attacks, and the inflammation is not always there. Triggers of gout attacks include:
- Having fever due to another illness
- Drinking a large amount of alcohol
- Eating a large fatty meal
- Dehydration
- Joint trauma
- Certain drugs
So, if you’re planning a barbecue with beers, make sure you don’t overdo it!
DIAGNOSIS
The diagnosis of Gout is usually done by a rheumatologist, a doctor who specializes in joint diseases, including gout.
Your doctor will ask you about your exact symptoms, how intense the pain is, and when it started. He/she will then ask about your diet, lifestyle, and alcohol consumption. After that, the affected joint will be examined for signs of inflammation and pain.
The medical interrogation and physical exam are usually enough to firmly establish the diagnosis. However, your doctor might order one or more of the following tests to confirm the diagnosis:
- Uric acid level: This is almost always ordered. The diagnosis of gout requires joint symptoms and confirmed hyperuricemia. Normal uric acid levels vary between gender and age groups, but generally, a uric acid level above 6 or 7 mg/dL is considered abnormal.
- X-ray: Radiologic imaging might be done to rule out other causes of joint inflammation, like trauma, bone infection, or rheumatoid arthritis.
- Joint aspiration: A sample of the joint fluid might be aspirated with a needle and tested to search for uric acid crystals. This is usually a simple procedure done in your doctor’s office
TREATMENT
During an acute gout flare-up, there are some things that you can do to deal with the symptoms. Treatment usually consists of a combination of medications and home remedies that can make a gout attack go away faster:
- Oral anti-inflammatory medications (NSAIDs), like ibuprofen, aspirin, and colchicine.
- Steroid injections or tablets
- Avoiding physical activity
- Lifting your feet up
- Applying ice packs to the affected joints
- Hydration
- Protecting the affected joint at night (e.g. with a cloth)
Chronic gout treatment may be required in those who have recurrent attacks or complications like kidney stones. It usually includes lifestyle changes and medications. The goal is to reduce the blood uric acid levels to prevent future gout manifestations:
- Medications to reduce uric acid, like allopurinol, febuxostat, and pegloticase.
- Weight loss
- Diet changes; reducing the consumption of red meats, liver, fish, veal, turkey, and other purine-rich foods.
- Avoiding high-sugar and high-fat foods
- Keeping alcohol drinking to a minimum
- Quitting smoking
- Doing sports more often
Gout is a lifetime disease, however, with modern medicine, it can be managed very effectively. Keep in mind that even the most effective medications will not be so effective if you don’t start changing your habits and leading a more healthy lifestyle.
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Sources
- https://www.cdc.gov/arthritis/basics/gout.html
- https://www.nhs.uk/conditions/gout/
- https://www.healthline.com/health/gout#causes
- https://www.arthritis.org/diseases/gout
- https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Gout
- https://www.nature.com/articles/s41584-020-0441-1
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