Gout is a metabolic disorder that results from the build-up of uric acid in the tissues or a joint, most
often the big toe joint. An acute attack of gout can be very painful, marked by intense pain that comes
on suddenly, redness, swelling, and warmth over the joint.  The increased warmth over the joint is
most noteable. Even light pressure, such as bedsheets, can cause remarkable pain. Gout usually
only affects one joint at a time. Usually there is no history of trauma.

Gout attacks are caused by deposits of crystallized uric acid in the joint. Uric acid is normally present
in the blood and eliminated in the urine, but in people who have gout, abnormally high amounts of
uric acid accumulates and crystallizes in the joints. Uric acid is the result of the breakdown of
purines, a protein that is found naturally in our bodies and in food.

Gout occurs most commonly in the big toe because uric acid is sensitive to temperature changes. At
cooler temperatures, uric acid turns into crystals. Since the foot is furthest from the heart, it’s the
coolest part of the body. However, gout can affect any joint in the body.

The tendency to accumulate uric acid is often inherited. Other factors that put a person at risk for
developing gout include: high blood pressure, diabetes, obesity, surgery, chemotherapy, stress, and
certain medications and vitamins. For example, the body’s ability to remove uric acid can be
negatively affected by taking aspirin, some diuretic medications or water pills, and the vitamin niacin.
While gout is more common in men aged 40 to 60 years, it can occur in younger men and also
occurs in post-menopausal women.

Consuming foods and beverages that contain high levels of purines can trigger an attack of gout.
You may be able to reduce your chances of getting a gout attack by limiting or avoiding the following
foods and beverages: shellfish, organ meats (kidney, liver, etc.), red wine, beer, and red meat.
Examination, blood tests (for excessive uric acid) and x-rays are used to determine the diagnosis.
Microscopic examination of a sample of the joint fluid, looking for uric acid crystals, provides the
most accurate diagnosis.

Initial treatment of an attack of gout may include the following:
  • Medications: Prescription medications are used to treat the pain, swelling, and inflammation.
  • Dietary restrictions: Foods and beverages that are high in purines should be avoided, since
    they are converted to uric acid in the body.
  • Fluids: Drink plenty of water and other fluids each day, while also avoiding alcoholic
    beverages, which cause dehydration.
  • Elevate the foot: Avoid standing and walking to give your foot a rest. Elevate your foot level
    with or slightly above the heart to help reduce the swelling.

The symptoms of acute gout and the inflammatory process usually resolve in three to ten days with
treatment. Medications are available that will limit the excessive production of uric acid.  

Repeated gouty attacks can cause gouty arthritis within big toe joint. This type of arthritis often
causes erosions or destruction of the surfaces of the joint.  Surgery may be required to remove the
uric acid crystals and repair the joint.
Advanced Foot and Ankle Specialists * Houston: 8200 Wednesbury Lane, Suite 210, Houston, TX  77074 * Sugar Land Location: 17510 West Grand Parkway South, Suite 440, Sugar Land, TX  77479