Joint pain has many causes. Gout is a common one, causing intense pain and inflammation in the big toe. Our article delves into the symptoms of gout and its causes, plus it gives some tips on pain relief.
What are the symptoms of gout?
Have you suddenly developed debilitating pain in your big toe? Is the joint red, shiny and swollen? Can’t even bear the weight of a sheet on your foot?
These are the classic symptoms of gout.
An attack of gout can develop rapidly. If it’s your first attack, it can be quite a shock. Sufferers have even been known to think they have broken their toe!
People who are familiar with the signs of gout may recognise an impending flare-up when they feel itching, burning or tingling in their affected joint. These warnings can precede an attack by a couple of hours.
Although gout usually affects one big toe, sometimes it happens in another joint, such as the smaller toes, ankle, knee, wrist or elbow.
As well as intense pain, you may have other signs that point to gout. Some people experience chills, mild feverishness and fatigue. If your fever is high, though, always seek medical advice – it may be the sign of an infection.
What’s happening in the body?
Gout is a type of inflammatory arthritis. It is due to a build-up of uric acid in the body. This acid can form tiny, sharp crystals that develop inside certain joints. They irritate the joint, causing inflammation and pain.
Uric acid is a by-product of digesting foods that contain substances called ‘purines’. Normally, the kidneys filter out excess uric acid. But sometimes, the body produces more than the kidneys can cope with, or there’s a problem with the removal process. This allows uric acid levels to build up in the blood.
It’s not clear why uric acid crystals deposit in certain joints. It may be because the temperature inside the joints is slightly lower than elsewhere in the body, allowing the crystals to form.
Some people can have a high uric acid level but never experience gout symptoms. Others are more susceptible. People who have certain medical conditions are more likely to develop gout. The risk factors include:
- high blood pressure
- kidney disease
- psoriasis (an auto-immune condition that causes scaly skin rashes)
Gout also runs in families. Around 20% of people who have gout have a close family member with the condition.
Many people think that only men get gout. In younger age groups, it is more common in men, but post-menopausal women are equally likely to suffer.
How is gout diagnosed?
Because gout causes joint pain, people sometimes come to see our osteopaths or physiotherapists. Our practitioners know the signs of gout, and if they suspect it’s the root cause of the pain, they refer the patient to their GP for further tests. A blood test can pick up raised levels of uric acid, although it’s often best to wait a few weeks as uric acid in the blood usually drops during a gout attack.
You can also have a joint fluid test to look for the presence of uric acid crystals or an ultrasound scan that can show crystals in the joint.
How is gout treated?
The first step is to manage the painful symptoms of a gout attack. This can be done with non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen, naproxen or diclofenac.
If these don’t work or you can’t take them, your GP may prescribe a medication called colchicine to reduce inflammation. Alternatively, corticosteroids can be taken orally or injected directly into the joint. However, both these medications can have side-effects, so discuss the pros and cons with your doctor.
The second step is to prevent gout attacks from recurring. Some people can do this through changes to their diet and lifestyle. For example, reducing the intake of purine-rich foods and drinks that aggravate gout symptoms can be enough to stop attacks. These include:
- oily fish and shellfish
- red meat, especially beef and lamb
- offal, such as liver, kidney and heart
- alcoholic drinks, especially beer and spirits
- drinks that contain high levels of sugar or fructose
In other cases, it’s best to take medication that reduces your uric acid levels. The most common of these is allopurinol. Taking this daily can prevent attacks, although it won’t help the pain if an attack happens.
What therapies can help gout symptoms?
During an attack, gout causes intense pain. But repeated bouts can also lead to erosion of joint surfaces, causing the joint to become inflexible.
Podiatrists are foot experts. If you have foot pain, they can carry out a health assessment to determine the cause. Where toe joints have lost mobility, they can prescribe custom orthotics to ease the pressure on the joint and improve your gait.
In addition, podiatrists can deal with those secondary foot problems that gout can trigger. For example, an ingrowing toenail is more likely to develop on a swollen toe.
Osteopaths and physiotherapists know a lot about keeping joints healthy. They can’t treat gout symptoms directly – that requires lifestyle changes or medication. However, your practitioner can help by:
- ensuring you maintain good joint flexibility.
- encouraging good mechanics throughout the body to reduce the load on an affected joint.
- giving you advice and support on how to implement changes that will benefit your health.
It’s not advisable to have treatment during a gout attack. You’ll be too uncomfortable. Wait until your symptoms have settled.
Our top tips to relieve gout symptoms
If gout strikes, there are some things you can do at home to help ease the pain. Try these tips:
- Apply ice to your sore joint. Use a cold pack for 15–20 minutes, or raw ice for 3–5 minutes. Repeat throughout the day, leaving breaks of 20–30 minutes in between icing sessions.
- Elevate your painful joint. Raising the joint helps by reducing blood flow, which can ease inflammation. Resting the joint also prevents movement from aggravating the pain.
- Drink plenty of water. This encourages good kidney function, which is key to flushing uric acid out of the system.
- Avoid clothes that constrict the joint. Make sure any cover is loose and comfortable.
- Drink cherry juice or take cherry extract. Cherries have anti-inflammatory properties, which have been proven effective for gout. Studies advise three servings over two days. But make sure your cherry juice doesn’t include high-fructose corn syrup – this can make gout worse!
Concerned about gout?
If you have joint pain and you’re not sure what to do, our expert team can advise you. Our osteopaths, physiotherapists and podiatrists are familiar with gout. If they suspect you have the condition, they will refer you to your GP for tests.
If you’ve recently been diagnosed, and you’re looking for advice, feel free to get in touch with us. Our team is here to support you in your quest for health.