Gout is one of a number of arthritic medical conditions and is a very common problem in the podiatrist office. It affects the big toe joint more often than any other area of the body. When gout presents in the big toe joint it may be called Podagra. Gout is seen more commonly in males or in post-menopausal females. A similar clinical picture is seen with Pseudogout.
Symptoms of gout are severe pain, swelling, and redness in a joint area. You may also notice the joint affected may be warmer to touch and there is some stiffness. It can be mistaken for trauma and for joint infection. Gout can also produce kidney stones which are made of uric acid.
Causes of gouty arthritis may be of metabolic or renal mechanism. The renal mechanisms are more common where the body does not rid itself of uric acid fast enough. This may be seen with low dose aspirin intake, thiazide diuretics, binge drinking of alcohol, or surgery. A high uric acid is also seen with a high intake of foods with high purine content such as organ meats (sweetbreads, liver, and kidneys), shrimp, sardines, anchovies, and dried legumes. The metabolic mechanisms involve the body producing to much uric acid too fast. With either reason hyperuricemia (excessive uric acid) in the blood stream results. In the extremities where the temperature of blood is lower, the high uric acid crystallizes in the tissues. This is especially true at the big toe joint. As the temperature drops and the solubility of the crystals decreases the uric acid precipitates according to the laws of chemical equilibrium. These crystals are called gouty tophi. As the body tries to rid itself of the crystals the lysozymes and enzymes break down the crystals causing severe pain in the surrounding tissue.
Prevention is to eat a low purine diet and limit your consumption of alcoholic beverages.
Diagnosis is first by clinical suspicion of symptoms. A blood test may be performed to see what the level of uric acid is in your body. The use of medications to treat the arthritis may also be used to aid in diagnosis. Sometimes an actual sample of fluid from surrounding the joint may be sent to the laboratory to detect the crystals present.
Podiatric Care may include using anti-inflammatory oral medications or an injection of medication and local anesthetic to reduce this swelling in the area. An injection may be used for both diagnosis and for treatment. When you go to your doctor, x-rays are usually required to evaluate the structure of your foot and ankle to ensure no other problems exist in this area.
Surgery for gout alone is usually not performed. Surgery may be performed when the arthritic destruction has occurred on the bone or at the joints. The procedure depends on what anatomical area is affected and the amount of degeneration or structural deformity.