Gout Foot - Symptoms, Pictures, and Treatment

Gouty arthritis is a disease of metabolism characterized by monosodium urate crystals in the joints and surrounding soft tissues (tophi). This arthritic disorder causes pain, swelling, and inflammation of the foot, and may extend to the leg.

Gout is caused by a defect in metabolism or breakdown of purines, resulting in excessive uric acid in the blood, caused by the kidney's inability to excrete uric acid normally. People with chronic conditions, such as diabetes, sickle cell anemia, and kidney disease, are at high risk for development of gout. Obesity is also a risk factor for gout.

The disorder has four stages, which include: asymptomatic (no symptoms), acute, intercritical, and chronic.

The onset of acute gouty arthritis of the foot can happen rapidly and mostly at night. On a scale of 1-10 the pain feels like 100. The foot is painfully swollen, and is red and tender to the touch.

The painful gout attack of the foot may resolve within several days, but can return at sporadic intervals lasting longer than a previous event. There is also a chance that it may never come back.

Risks:

• Men


• Postmenopausal women


• Use of alcohol


• Being overweight

Joints:

• 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 foot joint may show acute arthritis in the joints. Aspiration of the synovial fluid from an inflamed joint will show crystal formation comprised of urate. Elevated uric acid levels will also be present in the blood. X-rays may show no abnormalities.

Diagnostic Testing:

• Uric acid - urine


• Synovial biopsy


• CBC and differential

Treatment:

The goals of treatment are aimed at the elimination the pain, and reduction of inflammation. Prophylactic medications are prescribed to prevent of future 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.

Attacks of foot gout can progress to a more chronic condition. Left untreated to prevent future attacks, gout may return for a longer period of time and may also cause damage to the joints of the foot. Drinking ample amounts of water daily help to avoid the development of kidney stones.

by Barb Hicks, RN