Gout is a form of arthritis that is responsible for swelling, tenderness, and extreme pain. Usually, it affects the joints and mostly starts with the big toe.
Gout flares frequently begin in the big toe, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
Particularly in the middle of the night, gout attacks can occur suddenly and without warning, initially causing severe pain. For a couple of days or weeks, a gout episode can last. Some individuals may regularly experience gout flares, while others do not have a gout flare for years at a time.
Due to an excess accumulation of uric acid crystals in the joints and soft tissue, gout occurs , causing inflammation and severe pain.
Symptoms of gout in the big toe
Gout attacks include severe joint pain that arises unexpectedly, accompanied by swelling, tenderness, warmth, and redness or discoloration, including throbbing or burning joint pain.
It can affect the hands, elbows , knees, feet, and toes of an individual.
One report from 2018 notes that the discomfort can be so extreme for certain individuals that they can not bear the weight of a blanket. Within 6-12 hours, the symptoms are usually at their worst. In 1–2 weeks, the infected joint, or big toe, will recover.
The following are signs that a person is encountering a gout attack in the big toe:
- intense joint pain on the big toe
- rapid onset
- swelling and redness or discoloration
- difficulty moving
People who experience gout attacks can find it difficult to walk or stand because of extreme pain and swelling.
To treat gout in the big toe, a person may try the following:
If an person experiences a gout flare in the big toe, according to the Arthritis Foundation, they should contact a doctor to make an appointment.
In the meantime, they can:
- Take medication: A person can take nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Aleve), ibuprofen, and celecoxib (Celebrex). However, low-dose aspirin may exacerbate a flare.
- Elevate the foot and apply ice: This may ease inflammation and pain. Elevate the foot so that it is higher than the chest. Use an ice pack and apply to the toe for 20–30 minutes, several times a day.
- Drink fluids: Avoid alcohol and sugary drinks. A person should aim for 8–16 cups of fluid per day, half of which should be water.
To help alleviate pressure on the toe, a person may also use a cane or other mobility aids while they walk. They also suggest that the big toe be taken out of a pair of socks so that there is no strain on the toe. Open toe shoes or sandals are an option.
To avoid repeated gout attacks along with prescribed medications, a doctor can recommend lifestyle changes.
The following lifestyle improvements are recommended by the Centers for Disease Control and Prevention ( CDC):
- reducing alcohol intake and drinks with high sugars
- taking regular exercise and maintaining a moderate weight
- avoiding foods that may cause gout attacks, such as seafood, organ meat, and red meat
Typically, gout treatment includes medications.
Drugs can be chosen by a doctor depending on the condition. Medication can treat gout attack symptoms, avoid further attacks, and lower the risk of complications of gout, such as the development of tophi, according to NIAMS.
Tophi occurs when the crystals of uric acid build up and small lumps form. They can occur anywhere, but at pressure points, such as the elbows, or around hand or foot joints, they usually develop.
Medication can include:
- corticosteroids, such as prednisone
- colchicine, such as Colcrys or Mitigare
Causes and risk factors
Due to an abnormal accumulation of uric acid, or hyperuricemia, gout occurs.
Hyperuricemia is the major risk factor for developing gout, according to the National Institutes of Health ( NIH). A quarter of people with hyperuricemia, however, don’t develop gout.
When the body breaks down purines, it produces uric acid. The kidneys normally extract a certain amount of uric acid from the urine. However, uric acid crystals can form in the joints and soft tissues when they are unable to extract enough uric acid, causing swelling and pain.
The risk of developing gout can also be increased by genetics.
Other factors that can increase the risk of gout, according to the CDC, include:
- Diet: Food can play a role in the development of gout symptoms. Eating seafood, red meat, and drinking alcohol raises uric acid levels in the body.
- Weight: Having overweight increases the chance of developing gout.
- Medications: Certain medications, including diuretics and low-dose aspirin, are associated with gout risk because they increase the level of uric acid in the body.
- Other medical conditions: High blood pressure, diabetes, and kidney disease can increase gout risk.
How does diet affect gout?
NIAMS recommend avoiding foods high in purine, such as:
- seafood, including cod, salmon, and mussels
- organ meat
- red meat
- beverages high fruit sugars
Conversely, some foods have the possibility of reducing uric acid levels, the main cause of gout attacks.
- Cherries: A study has shown that cherries might potentially help lower the level of uric acid in the body, thus reducing gout attacks. However, it would be best to consult a doctor first.
- Vitamin C: According to a 2017 review, consuming vitamin C may increase uric acid excretion.
- Coffee: One study suggests that people who drink coffee regularly are less likely to develop gout. However, more research is needed to confirm these findings
In the United Kingdom, according to the National Health Service ( NHS), some people with gout can develop complications, such as:
- Kidney stones: When urate crystals accumulate in the urinary tract, kidney stones may develop.
- Tophi: These are typically painless, but can appear in awkward places, such as the toes, and can drain white chalky material.
- Joint damage: Some people may experience gout attacks frequently, while others may never have flare-ups. Without treatment, the gout attacks may occur more frequently and cause permanent damage to the joints.
Gout may be debilitating, but there are many improvements in lifestyles and diets that can help prevent gout:
- Maintaining a healthy body weight: Exercise and diet may help reduce uric acid levels in the blood.
- Reducing alcohol intake: Alcohol, especially beer and hard liquor, increases the risk of a gout attack. So, limiting or avoiding alcohol would help the body excrete excess uric acid in the urine.
- Drinking plenty of fluids: Stay hydrated and limit the intake of sugary drinks.
- Eat a low-fat and low-purine diet: Avoid food rich in purine, such as seafood and red meat. Instead, eat vegetables, low-fat dairy products, and plant-based proteins.
To diagnose gout, a doctor has to conduct multiple tests. A joint fluid test, which involves drawing fluid from the affected joint, is one of the tests. An indication of gout is the presence of urate crystals in the fluid.
In order to examine the levels of uric acid in the body, doctors may also conduct blood tests. The NIH notes, however, that certain individuals with high uric acid will never show symptoms of gout, whereas those with low uric acid may have gout attacks.
To find signs of urate crystals and assess the cause of the inflammation, doctors may also perform an X-ray or ultrasound.
When to see a doctor
Gout occurs without warning. Anyone with extreme pain in the big toe, accompanied by warmth, tenderness, redness or discoloration, should seek medical attention immediately.
It can lead to joint deterioration over time, including bone erosion and arthritis, if a person does not receive treatment for gout.
Usually, gout attacks begin with the big toe. Gout attacks can be painful and people usually need medicine to minimize the levels of uric acid and avoid the accumulation of uric acid and joint damage.
Changes in lifestyles and diets can help prevent future attacks.
An individual may raise the foot and apply ice to relieve pain, as well as take medication.