Gout Ankle - Symptoms, Pictures, and Treatment

Gout of the ankle (calcaneus bone) is an inflammatory arthritis of metabolic origin, marked by accumulation of urate crystals in the joints and soft tissues. This inflammatory disorder of arthritis causes pain, swelling, and inflammation, which can affect the whole foot, and possibly the lower part of the leg.

Ankle gout is the result of metabolism, or breakdown of purines in the body, that if not excreted by the kidneys can lead to a build up of uric acid in the blood. This can be a result of damage to the kidneys due to inefficient circulation to the kidneys. Chronic conditions, like diabetes, sickle cell anemia, and kidney disease, are factors that are conducive for development of gout. Obesity is another factor for gout.

The disease presents in four stages: asymptomatic (no symptoms), acute, intercritical, and chronic.

A gout attack of the ankle can happen quickly and most likely to occur at night. It is extremely painful and is accompanied by swelling and inflammation.

The painful gout attack of the ankle usually resolves within three days, but may recur at any time in the future. The next attack may last longer and can involve extensive damage to the affected joint.

Common risks include:

• Men between the age of 40 to 60 years of age


• Family history/genetics


• Postmenopausal women over 60 years of age


• Use of alcohol


• Being overweight

Joints of attack include:

• Hips


• Knees


• Ankles


• Feet


• Shoulders


• Elbows


• Wrists


• Hands

The great toe (podagra), knee, or ankle joints are commonly affected, and can be combined with swelling, stiffness, warmth, and redness.

Tophi: Is the accumulation of urate crystals in the soft tissue, appearing as lumps, surrounding the affected joint, and may drain a chalky material.

Diagnosis:

Physical assessment of the calcaneus bone (ankle) joint may show acute arthritis. Biopsy of the synovial fluid, aspirated from the ankle joint using a needle, may exhibit urate crystals formation. Elevated uric acid levels will also be present in the blood samples drawn for testing. X-rays will most likely be normal, as an acute attack will not show any joint abnormalities.

Diagnostic Testing:

• Uric acid - urine


• Synovial biopsy


• CBC and differential

Treatment:

The goals of treatment are focused on pain and inflammation reduction, as well as medications to prevent further attacks. Medications include:

Colchicine: Reduces pain, swelling, and inflammation. Successful pain management occurs within 12 hours of initiating treatment, with total relief in two days. However, colchicine does not decrease uric acid levels in the blood, but used in conjunction with allopurinol helps to avoid future attacks.

NSAIDs (non steroidal anti inflammatory drugs) are effective for management of pain and inflammation.
Corticosteroids injected into the inflamed joint is also effective for pain management.
Codeine or other analgesics may be prescribed to reduce pain.

Undiagnosed gout of the ankle will lead to disease progression through the four stages of gout, with the intervals eventually dissipating into the chronic stage of constant pain and inflammation. If you are having symptoms of gout, it is important to get medical treatment to prevent complications, particularly if you have any other underlying chronic condition, such as diabetes.

by Barb Hicks, RN