You lime, you parang, you eat, you drink, you had a merry ole time. For some, after the festivities, the reality of it all hits. In some, it’s the back and foot pains from over doing, with cleaning and Christmas parties. With others, it is the extremely elevated blood glucose levels. Finally, in the area of focus today, from too much drinking and eating the wrong things, or too much of the Christmas things, gout can rare its head.

If the joint of your big toe is hot, swollen, red, and it’s unbearable to allow anything to touch it, there’s a chance you could have gout; or more specifically, gout in the big toe. Gout is a type of inflammatory arthritis, caused by a build-up of uric acid levels in the affected person’s body. While the production of uric acid is a normal process of human metabolism, increased levels in your blood, could cause an “attack” of gout.

These attacks occur, when the uric acid forms crystals, that become deposited in joint spaces. These spikes of the acid cause the pain, swelling, and hyper-sensitivity, so common in the affected area; imagine having a bunch of little needles inside your toe! These crystals have also been found to form tophi (build -ups) on the skin, and stones in the kidneys. Most gout attacks occur at night, since the body temperature lowers, and prompts the uric acid to precipitate into jagged little crystals.

Diagnosing Gout

A simple blood test will reveal an elevated uric acid level. A more comprehensive test for diagnosis is by a procedure called joint aspiration. In this procedure, your doctor will use a needle to draw out fluid from the affected joint cavity. The fluid will then be analysed for urate crystals, as well as bacteria, to rule out infection of the joint as the cause for pain (Septic Arthritis). X-rays are also utilised to determine the extent of gout, and to monitor both bone and joint damage.

A newly diagnosed patient suffering from gout, should be assessed for underlying causes, that may be aggravating the hyperuricemia (excessive uric acid). Factors that have been found to be associated with gout include obesity, diabetes, hypertension, diuretic use, alcohol intake, and a diet of foods rich in purines. Gout tends to run in families.  Patients are therefore encouraged to ask their parents and grandparents, for information about other family members having a history of it.

Foods Notorious for High Levels of Purines

• Beer and other alcoholic beverages
• Organ meats (liver, kidneys)
• Dried beans and peas
• Fried foods and trans fats
• Asparagus
• Gravies, meat extracts, cream sauces
• Salmon, Haddock, Sardines, Mackerel or Herring, and Anchovies
• Shellfish, clams, lobsters, mussels, scallops and shrimp
• Bacon, Lamb and Turkey
• Yeast and yeast derived products
• Extreme Foods to Avoid: Artificial sweeteners, Carbonated drinks, Cigarettes, Flour (white wheat), Goat, Lamb, Pastries and cake from white flour, Pork, Sugar, Beer, Brown Sugar, Deer, Chocolate, Coffee, Custard with white sugar, Jams, Jellies, Liquor, Pasta, Rabbit, Table salt – refined and iodized, Tea (Black), White Rice, Vinegar.

See a dietician/nutritionist for proper guidelines.

Management and Treatment

It should be targeted at reducing the circulating levels of uric acid in the body long-term, while also treating flare-ups, and reducing the arthritic damage that can be caused by severe chronic gout. Gouty attacks can be prevented, or at least made to happen less frequently, in a number of other ways, beside watching dietary intake of Purine-rich foods. Weight-loss, drinking plenty of fluids, changing certain medications, and adding medications like Allopurinol can help too.

Usually NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) like Ibuprofen or Naproxen, will be prescribed to alleviate the pain associated with the flare-ups. Corticosteroids may also be prescribed, but an individual treatment plan is always best for the management of any ailment.

Treatments vary depending upon the severity of each attack. One must take into account how long it has been since the symptoms first started, as well as how many previous attacks have occurred. The overall medical history of each patient, and the medications already prescribed, must be considered.

First time treatments may involve a cortisone injection into the affected joint, with a prescription to reduce the uric acid, and relieve the pain. If attacks persist, and the uric acid levels remain elevated, then long term prescription management is recommended. Helpful supplements for treatment are cherries and cherry juice, celery, pineapple, and turmeric.

Remember that this condition not only affects the great toe, but often occurs in other joints in both the foot and the rest of the body. First time attacks usually occur in the great toe, but secondary attacks may go to other joints in the foot, ankle, or other body parts.

If left untreated, the consequences may be chronic pain, or destruction of the joint where the gout occurred, resulting in permanent arthritis pain. Also, gouty tophi may appear as whitish nodules around the joints. These are often painful/visible, and result in permanent changes to the bone and joint.

Visit your doctor or podiatrist for help in managing.

Your feet mirror your general health . . . cherish them!