Painful Red Feet??? What's that all a- GOUT??

      When my patients come in to see me saying they have a 10/10 pain of their great toe and cannot even let their bed sheet touch their foot, I automatically think of gout.  Usually the pain has come on overnight with no history of injury.  The pain of an acute gouty attack can be excruciating and may be triggered even by light touch or movement.  The pain can be so severe that some people even resort to emergency room treatment for pain relief.  Gout is caused by having increased levels of uric acid in your blood and then having the body react to these increased levels meanwhile causing pain and inflammation.  Most of the time the increase in uric acid levels is caused by something they have eaten.

What is happening?
     Uric acid is a product of the break down of purines in your body.  Your body not only produces purines but you can store larger amounts of uric acid secondary to a protein rich diet.  Too much of anything can be bad for you and this is very true with uric acid.  Your body thinks of the excess uric acid as an unwanted house guest and attempts to get rid of it by sending your immune cells to make it go away.  The immune response causes pain, swelling, warmth, and redness that typically accompanies an acute gouty attack.  The attacks can last between 3-5 days and prompt treatment will decrease symptoms fairly quickly.

  

     The most common person to have a gout attack is a male between the ages of 30-45.  Women usually have attacks starting post menopause, between the ages of 55 and 70 years of age.  If you have a family history of gout your chances increase as well.  Other medical conditions such as kidney disease, high blood pressure, and diabetes can also contribute to the prevalence of gout.  Medications such as diuretics (water pills) and also aspirin have shown they may increase uric acid levels. Finally, being overweight and consuming large amounts of alcohol can contribute to the cause of a gouty attack.  Certain foods that are good for you may still cause an increase in your uric acid level.

What should I do?

     So what can you do if you have a red, hot, swollen, and tender foot? You can easily try some simple home remedies such as applying ice to the affected area, elevating the limb, resting the limb, and using over the counter non-steroidal anti-inflammatory drugs (NSAID) such as naproxen or ibuprofen if okay with your doctor.  Essentially what you are trying to do is decrease that inflammatory response the body has when encountering high levels of uric acid.  You are trying to prevent the swelling and warmth by counteracting it with anti-inflammatory methods.  This is very effective and some people require no further treatment.

    If by chance your pain persists your doctor may prescribe you a stronger NSAID, such as colchicine or indomethacin, or a steroid to calm the inflammation down.  Doctors could also inject a local anti-inflammatory into the affected area and this would also decrease pain and swelling dramatically.

After the acute attack and everything starts to calm down, you may have to repeat a blood test to make sure your baseline uric acid levels are normal.  If they are elevated when no attack is happening then your doctor may consider placing you on a maintenance medication, such as allopurinol or probenecid, so as to prevent future flare ups.  You may also try to lose weight, drink lots of water, and avoid large consumption of alcohol and meats.  There are lists of certain foods that can increase and decrease the levels of uric acid. 

    If gout is something you may have problems with, schedule an appointment with us today.