Gout is a disorder/condition that results from the build-up of uric acid in the tissues or a joint. The most common location of pathology in the body is the big toe joint.
Causes
Gout attacks are due to deposits of crystallized uric acid in the joint (most common the big toe joint). Uric acid is present in the blood and eliminated in the urine, in people who have gout, uric acid accumulates and crystallizes in the joints. Uric acid is the result of the breakdown of purines, chemicals that are found naturally in our bodies and in food.
Patients can often times develop gout because of difficult kidneys eliminating increased or decreased amounts of uric acid.
Gout occurs occurs in the big toe because uric acid is sensitive to temperature changes. At cooler temperatures, uric acid turns into crystals. The big toes is the furthest away from the heart having the one of the coolest temperatures in the body and the most common place for gout to develop. It can occur in other joints as well.
Factors for developing gout include: familial history, high blood pressure, diabetes, obesity, surgery, chemotherapy, stress, medications and vitamins. Aspirin, diuretic medications, niacin vitamins can affect the body’s ability to remove uric acid. Gout is most common in men aged 40-60 years.
Symptoms
- Intense pain that comes on suddenly, often in the middle of the night or in the morning.
- Signs of inflammation such as redness, swelling, and warmth over the joint.
Diagnosis
To diagnose gout, your surgeon will ask questions about your social and family history. Laboratory tests and x-rays are ordered to diagnose as well as evaluate if the inflammation is caused by something other than gout.
Non Surgical Treatments
Gout is initially treated without surgical intervention. Initial treatment includes:
Medications. Prescription medications are used to treat the pain, swelling, and inflammation.
Dietary restrictions. Foods and beverages high in purines (i.e. alcohol, red meats) should be avoided.
Fluids. Drinking increase amounts of water and other fluids each day will help with the symptoms, while also avoiding alcoholic beverages.
Immobilization/Rest. Immobilization may involve the use of a short leg cast or removable walking boot to reduce the strain and forces.
Elevation. Elevate your foot (slightly above the heart) to help reduce swelling.
The symptoms of gout and the inflammatory process typically resolve in 3-10 days with treatment. If symptoms continue despite this initial treatment, or if repeated attacks occur, it is advisable to see your primary care physician for maintenance treatment that may involve daily medication. Surgery may be indicated to clean out the joint of the crystalized deposits.
Surgery
Although most patients respond successfully to non surgical treatment, a small percentage of patients may require surgery to clean out the big toe joint.
Surgery is typically an outpatient procedure (day surgery) and scheduled at your convenience.