The most painful condition that we see in the office is a gout attack, which is considered to be one of the most painful types of arthritis you can experience. If you’ve ever had one you’d know how truly disabling this can be. The condition is most prominent in men and has a 3:1 ratio of men to women, with men ages 40-50 being the most prevalent group. Women, if affected, will develop gout after going through menopause. This is due to the effects of estrogen keeping the uric acid levels in check.
Gout is described as a sudden onset of severe pain, tenderness, warmth, redness, and swelling from inflammation of the affected joint. Most often, it affects a single joint with the big toe affected more commonly than any other. The knee, ankle, heel and other joints can be affected, but are less likely.
An attack of gout in the big toe joint presents as a moderate to severely swollen area that is as red as a fire engine and very warm. So warm, or hot is more like it, that if you place your hand above the area a few inches you can feel the heat come off of it. Also, the pain can be so excruciating that even the bed sheets are unable to touch it. Gout has a tendency to flare up over night when your body temperature drops and the uric acid crystals settle into the joint tissues.
The cause of gout is a high blood level of uric acid, which can mount up in joints and lead to inflammation. Uric acid is a by-product formed from the breakdown of purines (substances which are found naturally in your body and in certain foods such as proteins.)
Although many people can have a high level of uric acid and not even be aware or affected by it, some are. Genetics, like most things, does play an important part in whether or not you’d be likely to develop this painful condition, but this is not a guarantee.
Other events which may bring on a gout attack include certain medications, fever, dehydration, trauma to the affected area, and recent surgery.
There are basically two classifications of gout. Those who are over-producers of uric acid and those who are under-excretors. Over producers have a tendency to break down certain foods too quickly for the body to metabolize and rid itself of the uric acid. Patients with certain metabolic disorders will most likely fall under this category, although this is a smaller percentage of those affected. The under-excretors are not processing the end product, uric acid, quickly enough and therefore a build-up develops.
There are a number of factors that dictate which medication you may be placed on for the short or long term. This is for your physician(s) to decide. For acute painful attacks, either your PCP or your Podiatrist can prescribe medication that will alleviate the symptoms for the short term. Always inform any medical specialist which medications you are taking. It is extremely important that we have a complete list to avoid any complications. This includes any vitamin or herbal supplements.
If you think you are having a gout attack anti-inflammatory medications can help until you see your physician. I don’t suggest waiting it out and thinking it’ll get better on its own. It may, but most likely won’t. It’ll take ALOT longer than you think. Unless, of course, you don’t mind walking around the neighborhood wearing 1 slipper. You certainly won’t have to worry about being invited to anymore barbecues. Patients will come in the office limping and wearing a slipper on the affected foot and it’s usually pretty clear why they’re here.
FEET. It’s what we eat, drink and sleep each and every day. Okay, yuck! Not the most pleasant of thoughts, I agree. But wouldn’t you rather entrust yours or your own child’s feet to someone who has the training and specialization in this area? I know I would want my own daughter to see a specialist for whatever ails her. As always, if you have any questions regarding your overall health, please see your primary care physician. If you ever have any concerns of the health of your feet, please do not hesitate to contact your Podiatrist for a comprehensive foot, ankle and lower extremity evaluation.
Foods to Avoid
Organ meats
Herring, mussels, scallops
Yeast, bacon, veal
Smelt, sardines, anchovies
Grouse, mutton, pheasant
Haddock, trout
Turkey, partridge, goose
Alcohol
*remember that purines are found in high protein food. While all sources of purines should not be eliminated, they should be taken in moderation
Foods to Eat
Fresh Fruit: cherries, strawberries, blueberries, bananas, pineapples, tangerines, mandarin oranges, fruit juices
Vegetables: celery, tomatoes, kale, red cabbage, parsley, red bell peppers, green leafy vegetables
-potatoes
-purified water (8 glasses per day)
-complex carbohydrates: breads, cereals, pasta, rice
-chocolate, cocoa
-coffee
-tea
-carbonated beverages
-fatty acids: tuna, salmon, flaxseed, nuts, seeds
-tofu
Risk Factors
-Obesity
-hypertension
-diabetes
-hyperlipidemia
-alcohol ingestion
-abnormal kidney function
-hypothyroidism
