Gout is a form of inflammatory arthritis caused by a build-up of uric acid that crystallizes in a joint, most often the big toe. Attacks tend to strike suddenly — frequently overnight — and can be intensely painful. The good news is that gout responds well to treatment: an acute flare can usually be brought under control within days, and ongoing flares can often be prevented with the right plan.
If you've ever woken up with a big toe that's swollen, red, hot, and so tender that even a bedsheet is unbearable, you may be dealing with a gout flare. It's one of the more distinctive conditions we see in Farmington and South Ogden — distinctive because it comes on fast, but also very treatable once it's correctly diagnosed.
What is gout?
Gout results from the build-up of uric acid in the tissues or a joint. Uric acid is produced when the body breaks down purines, substances found naturally in the body and in certain foods. Normally, uric acid dissolves in the blood and is filtered out by the kidneys. When it accumulates faster than the body can eliminate it — because of impaired kidney function, excess production, or both — it can crystallize and settle in a joint, triggering a sudden, painful inflammatory flare.
The big toe is the joint most commonly affected. Because it's the part of the body farthest from the heart, it also runs cooler than other joints, which makes it a more favorable environment for uric acid crystals to form. Gout can also affect other joints of the foot and ankle.
What causes gout, and who is at risk?
Gout develops when uric acid accumulates and crystallizes in a joint. A number of factors can raise the risk of developing gout or triggering a flare, including:
- High blood pressure
- Diabetes
- Obesity
- Recent surgery
- Chemotherapy
- Significant physical or emotional stress
- Certain medications, including aspirin, diuretics, and niacin
- A family history or genetic predisposition to gout
Gout most commonly affects men between the ages of 40 and 60, though younger adults and women can develop it as well, particularly after menopause. Diet plays a role too — foods and drinks high in purines, such as shellfish, organ meats, red meat, beer, and red wine, are common triggers for people prone to gout. Because gout is a form of inflammatory arthritis affecting the big toe joint, it can sometimes be confused with other big-toe conditions such as hallux rigidus or a bunion, which is why a proper evaluation matters.
What are the symptoms of a gout attack?
A gout flare typically causes:
- Intense pain that comes on suddenly, often in the middle of the night or upon waking
- Redness over the affected joint
- Swelling of the joint
- Warmth in the affected area
The pain can be severe enough that even the weight of a bedsheet on the toe is uncomfortable. Left untreated, a flare can last anywhere from a few days to a couple of weeks, and some people go on to experience recurring episodes.
How is gout diagnosed?
Diagnosis starts with a review of your medical history and a physical examination of the affected joint. Because several other conditions can cause similar sudden joint pain and swelling — including infection or other forms of arthritis — laboratory tests and X-rays are sometimes used to help confirm gout and rule those out.
How is gout treated?
Treatment for an active flare focuses on reducing pain and inflammation as quickly as possible. This typically includes:
- Prescription medications or injections to reduce pain, swelling, and inflammation during a flare
- Avoiding high-purine foods and beverages, such as shellfish, organ meats, red meat, beer, and red wine
- Increasing fluid intake while limiting alcohol consumption
- Immobilizing and elevating the affected foot to reduce strain and swelling
With treatment, the symptoms of a flare and the associated inflammation usually resolve within three to ten days. If your symptoms persist or flares keep recurring, ongoing or repeated episodes may call for maintenance medication to control uric acid levels over the long term — managing gout is best thought of as an ongoing process rather than a one-time fix.
When should you see a podiatrist for gout?
See a podiatrist promptly if you have sudden, intense pain, redness, swelling, or warmth in your big toe or another joint of the foot, especially if it woke you from sleep. Because gout can be mistaken for other conditions like infection or a different type of arthritis, an evaluation helps confirm the diagnosis and get you the right treatment quickly. When you're ready, you can request an appointment at either of our Northern Utah offices.
Medically reviewed by the physicians at Wasatch Foot & Ankle Institute. Our board-certified, fellowship-trained podiatrists provide foot and ankle care in Farmington and South Ogden, Utah. This article is for general education and is not a substitute for an in-person evaluation.