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What is Gouty Arthritis and why does it affect my Great Toe?

 What Is Gout?

Gout is a metabolic disorder that results from the build-up of uric acid in the tissues or a joint. It most commonly affects the joint of the big toe but can affect any joint. Other likely joints in the lower extremity are the joints of lesser digits, and ankles.

Causes

Gout attacks are caused by deposits of crystallized uric acid in the joint. Uric acid is present in the blood and eliminated in the urine, but 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. Some people develop gout because their kidneys have difficulty eliminating normal amounts of uric acid, while others produce too much uric acid.

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 toe is the part of the body that is farthest from the heart, it's also the coolest part of the body - and, thus, the most likely target of gout. 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 ("water pills"), and the vitamin niacin (also called nicotinic acid). While gout is more common in men aged 40 to 60 years, it can occur in younger men as well as in women.

Consuming foods and beverages that contain high levels of purines can trigger an attack of gout. We have provided a list of foods to avoid if you have gout or if this condition affects someone you know. Some foods contain more purines than others and have been associated with an increase of uric acid, which leads to gout. You may be able to reduce your chances of getting a gout attack by limiting or avoiding shellfish, organ meats (kidney, liver, etc.), red wine, beer, and red meat.

Symptomsgout

An attack of gout can be miserable, marked by the following symptoms:

  • A Red, Hot and Swollen Joint, often at the level of the great toe.
  • Intense pain that comes on suddenly - often in the middle of the night or upon arising
  • Signs of inflammation such as redness, swelling, and warmth over the joint.

 

Diagnosis

To diagnose gout, the foot and ankle surgeon will ask questions about your personal and family medical history, followed by an examination of the affected joint. Laboratory tests and x-rays are sometimes ordered to determine if the inflammation is caused by something other than gout.

Treatment

Initial treatment of an attack of gout typically includes the following:

  • Medications. Prescription medications or injections are used to treat the pain, swelling, and inflammation.
  • Dietary restrictions. Foods and beverages that are high in purines should be avoided, since purines are converted in the body to uric acid.
  • Fluids. Drink plenty of water and other fluids each day, while also avoiding alcoholic beverages, which cause dehydration.
  • Immobilize and elevate the foot. Avoid standing and walking to give your foot a rest. Also, elevate your foot (level with or slightly above the heart) to help reduce swelling.

The symptoms of gout and the inflammatory process usually resolve in three to ten days with treatment. If gout symptoms continue despite the initial treatment, or if repeated attacks occur, see your primary care physician for maintenance treatment that may involve daily medication. In cases of repeated episodes, the underlying problem must be addressed, as the build-up of uric acid over time can cause arthritic damage to the joint.


Dr. Craig H. Thomajan
Founder and Managing Partner of Austin Foot and Ankle Specialists

The Jefferson Building

Austin Foot and Ankle Specialists is pleased to announce that we have opened a second practice location in Central Austin. Our new clinic is located at:
The Jefferson Building
1600 West 38th Street, Suite 318
Austin, Texas 78731
512-328-8900

The new central location will offer Austin Foot and Ankle Specialists’ entire suite of full-treatment medical capabilities, including on-site X-rays. Other ancillary modalities, such as MLS laser therapy, EPAT radial pressure wave treatment and Physical Therapy, will only be available at the Westlake offices.
Austin Foot and Ankle Specialists’ central offices will initially offer abbreviated hours, including:
1st & 3rd Tuesdays of the Month – 8 a.m. until 5 p.m.
2nd & 4th Thursdays of the Month – 8 a.m. until 5 p.m.

We anticipate moving the new clinic to full time hours within the first six months of operation.
Austin Foot and Ankle Specialists looks forward to serving you and your family, and we hope that our locations in Westlake and Central Austin will make it easier than ever before to maintain your foot and ankle health.

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