If you’ve ever woken up in the middle of the night with sharp, searing pain in your big toe, you may have experienced gout. This pain can be so intense that even the smallest movements become overwhelming, affecting your mobility and making daily activities, like walking or standing, difficult.
It’s important to understand that certain groups are at greater risk of developing gout, and knowing where you fit can help manage your risk. For example, men, particularly those in their 30s and beyond, are more susceptible. This increased risk is linked to the fact that uric acid levels tend to rise naturally as men age. Similarly, women face a greater risk of gout after menopause due to hormonal changes. Specifically, the decline in oestrogen levels during this time can reduce the body’s ability to remove uric acid effectively, thereby making women more vulnerable to it. Therefore, by identifying these risk factors, you can take proactive steps to reduce the likelihood of future gout attacks. With this understanding in mind, let’s now explore the causes of gout and ways to manage it.
Causes of Gout
Gout occurs when the body struggles to manage rising levels of uric acid. As uric acid accumulates in the bloodstream, it eventually forms needlelike crystals in the joints, which the immune system identifies as foreign invaders. This triggers an inflammatory response, resulting in swelling, redness, and significant pain.
The big toe joint is particularly vulnerable, with over 90 per cent of gout cases involving this area. Its distance from the heart makes it cooler, and since uric acid crystallises more easily at lower temperatures, the big toe becomes an ideal spot for these crystals to form, leading to discomfort and inflammation.
Several factors contribute to elevated uric acid levels, each playing a role in the onset of these painful episodes:
- Dietary Influences: One major factor is diet. A diet rich in purines can lead to increased uric acid production. As purines are metabolised by the body, uric acid is produced, and foods like red meat, shellfish, alcohol, and sugary drinks can significantly raise uric acid levels, especially in those predisposed to gout.
- Excess Uric Acid Production: Some individuals may produce more uric acid than their bodies can handle. This overproduction often results from genetic factors, metabolic disorders, or certain medical conditions like leukaemia. Additionally, treatments such as chemotherapy can further increase uric acid levels.
- Kidney Inefficiency: The kidneys play a crucial role in filtering uric acid from the bloodstream. However, when its function is impaired by chronic conditions, excessive alcohol use, or certain medications like diuretics, the body struggles to remove uric acid, leading to a higher risk of crystal buildup and painful gout attacks.
4 Stages of Gout
Gout progresses through four distinct stages
Stage 1: Asymptomatic Gout
In this stage, uric acid slowly builds up in the blood, a condition known as hyperuricemia. Though uric acid crystals begin to form in the joints, there are no noticeable symptoms. This stage can persist for years, as the body silently accumulates uric acid, creating the potential for future gout flare-ups if the condition remains unmanaged.
Stage 2: Acute Gout
As the crystals form in the joints, they trigger sudden and severe pain, along with swelling and inflammation. Diagnosis is confirmed through joint fluid analysis, where they are identified. It’s essential to differentiate this from pseudogout, which presents similar symptoms but involves calcium pyrophosphate crystals and thus requires a different approach.
Stage 3: Intercritical Gout
After an acute attack subsides, gout enters a symptom-free phase known as intercritical gout. Despite the lack of symptoms, uric acid continues to build up in the joints, increasing the risk of future attacks. This phase can last anywhere from months to years, depending on the individual’s uric acid levels and how well the condition is managed.
Stage 4: Chronic Tophaceous Gout
If left ignored, gout can advance to chronic tophaceous gout, the most severe form of the condition. Large deposits of urate crystals, known as tophi, develop in joints and tissues, causing pain and deformity. Over time, these tophi can lead to joint damage, restricted movement, and other complications such as kidney stones.
Symptoms of Gout
Gout attacks are sudden and often start with a warm, throbbing sensation that quickly turns into sharp pain. While symptoms may ease within a week, some effects can linger. Gout primarily affects the lower limbs, such as the big toe, foot, ankle, heel, instep, and knee. The key symptoms include:
- Intense Joint Pain: Pain peaks within the first four to 12 hours, making it difficult to bear weight or move the affected joint.
- Lingering Discomfort: After the initial pain subsides, discomfort can last for days or weeks, with repeated attacks often lasting longer.
- Inflammation and Tenderness: The joint becomes swollen, warm, and red, with surrounding skin becoming tender and sensitive to touch.
- Reduced Movement and Stiffness: Stiffness and limited range of motion may occur, making movement more difficult.
Take Control of Gout with East Coast Podiatry
If you’re struggling with knee, ankle, or foot pain and suspect it’s gout, taking swift action is key. At East Coast Podiatry, Singapore’s leading podiatry clinic, we offer comprehensive evaluations using advanced tools like ultrasounds to accurately diagnose your condition and understand the extent of the problem.
While medication may provide temporary relief, they don’t address the deeper joint and bone damage caused by recurring gout attacks. That’s where our non-invasive methods, ESWT and EMTT, come in. These advanced technology not only reduce pain and inflammation, they also promote healing. After addressing the immediate pain, our approach shifts toward long-term care, using customised in-shoe orthotics to stabilise your joints, improve mobility, and prevent future complications, ensuring your overall foot health.
Contact us today, and our experienced podiatrists will work closely with you to develop a personalised care plan. By addressing both the acute and long-term effects of gout, we’ll help you manage the condition and regain comfort and mobility.
