Gout is a common and complex form of arthritis that can affect anyone. Gout in big toe is characterised by a sudden and intense attacks of pain in the joints of the big toe. A gout attack can even wake you up in the middle of the night, although it can also occur first thing in the morning. It usually affects one joint at a time, mainly the big toe joint.
Podagra, or gout in big toe, is a form of gout that affects the joints of the foot or toes and results in acute, painful inflammatory episodes or attacks. The inflammation is caused by excess uric acid forming small crystals in and around the joints.[1]
How is the pain of Podagra?
Acute attacks of gout are characterised by the rapid onset of pain in the affected joint, followed by heat, swelling, reddish discolouration and marked tenderness. Some people even report feeling as if the affected area is on fire. The small joint at the base of the big toe is the most common area for an attack. Other joints that may be affected are the ankles, knees, wrists, fingers and elbows. It rarely affects the shoulders, hips and spine. If you have gout in one joint, it does not mean that it will spread to the other joints.[2]
In some people, the acute pain is so severe that the slightest touch of the bed sheet to the toe causes acute pain. These painful attacks usually subside within hours or days, with or without medication. In rare cases, an attack can last for weeks. Most people with gout will have repeated attacks over the years.[3]
Risk factors
Obesity, excessive weight gain, especially in young people, moderate to heavy alcohol consumption, high blood pressure and abnormal kidney function are among the risk factors for developing gout. Certain medications and diseases can also cause high levels of uric acid. In addition, there is an increased prevalence of abnormally low levels of thyroid hormones (hypothyroidism) in patients with gout.
Diagnosis of Podagra
Podagra is considered when a patient reports a history of repeated attacks of painful arthritis at the big toe. The most reliable test for gout is the detection of uric acid crystals in joint fluid obtained by joint aspiration. This procedure is performed under topical local anaesthetic. Using a sterile technique, fluid is withdrawn (aspirated) from the inflamed joint using a syringe and needle.
However, a full blood work-up, X-rays and an overall assessment of the patient’s health is the first line of assessment for gout.
Symptoms of gout in Big Toe include
Pain: Tiny, sharp crystals build up under the skin and around the joint, causing pain that can be severe. The most intense pain usually occurs in the first 12 to 24 hours of the attack.[4]
Swelling: Sometimes the joint becomes swollen, i.e. larger. The appearance of a gout attack in the joint may resemble swelling caused by a blow.
Redness: The joint may appear red.
Warmth: You may feel that the joint is warm, as if it is giving off heat. It may feel warm to the touch. When describing gout pain, some people say that the joint feels like it is on fire.
Stiffness: In more severe cases of gout, the joint may become stiff. This stiffness may appear over time after several gout attacks, especially in cases of chronic gout.
More info here: Gout Symtoms.
After the inflammation from a gout attack has gone away, it is recommended to follow a long-term treatment to reduce the level of uric acid in your blood and the frequency and severity of future attacks.[5] These medications should not start until several days or weeks after a gout attack has ended. Long-term treatment depends on uric acid levels and the likelihood of recurrent gout attacks.[6]
Treatment of Gout
Gout treatment consists of managing the gout attack and preventing recurrences and possible complications. It is taken for life; regular medical follow-up is necessary.
The aim of gout treatment is to treat the gout attack and to eliminate the pain.
It also allows, thanks to a basic treatment, to prevent :
- the recurrence of gouty attacks;
- the formation of tophi ;
- joint complications;
- the appearance of kidney stones.
Background treatment is effective if the uricemia falls below a threshold value in order to obtain the dissolution of urates (salts of uric acid).
Gout is a chronic disease that requires lifelong treatment and multidisciplinary management, involving the treating physician, a rheumatologist, a cardiologist, a nephrologist, etc. This is to control the gout but also the associated cardiovascular risk.
The first step in treatment is to rest the joint affected by gout (resting the foot if a toe joint is affected, for example). A device, such as an orthosis, can be proposed to relieve the joint (for example, the wrist).
In order to reduce the inflammation, it is recommended to cool the joint with ice. The ice should not be placed directly on the skin to avoid the “burning” sensation caused by the cold. It is preferable to put it in a clean cloth before putting it on the inflamed joint (often the big toe). The operation can be repeated at home, every 4 hours; this shortens the duration of the gouty attack.
Here Natural Remedies: Curcumin and Boswellia.
Gout Home Remedies
What is the fastest way to get rid of gout?
To get rid of gout, you must lower your uric acid level. And the best way to lower high uric acid is to improve our diet. It is very important to eliminate foods that raise uric acid and introduce others that are healthier for the body. The first thing to do is to avoid foods rich in purines.
To lower high uric acid, we must always maintain good hydration in the body. We must drink between 1.5 and 2 liters of water a day to stimulate kidney function, since the purines that raise uric acid are eliminated through urine.
Read more: What is the fastest way to get rid of gout?How do you treat gout in the big toe?
- Take medications, such as colchicine and corticosteroids.
- Drink water to stay hydrated. If you are fluid restricted due to kidney failure, talk to your doctor or dietitian about gout and fluid management.
- Do not drink alcohol or eat foods high in purines.
- Take stress off the joint. For example, try walking with a cane.
- Elevate the affected joint.
- Apply a cold pack to keep the joint cool.
- Find ways to relieve tension caused by pain, such as deep breathing and meditation.
Read more: How do you treat gout in the big toe?How do I know if I have gout in my big toe?
The most frequent form of gout is to suffer attacks of inflammation in the first metatarsophalangeal joint, that is to say, the one that joins the big toe to the rest of the foot, mainly in its external face. It is usually an acute and very painful process that starts at night or first thing in the morning, and with such intense swelling and pain that it can even wake you up and make even the slightest friction annoying.
An attack of gout can occur suddenly and can often cause you to wake up in the middle of the night with the feeling that your big toe is on fire.
The toe is hot, swollen and so tender that even the weight of a bed sheet may seem intolerable. It is often accompanied by erythema or redness of the skin surrounding the joint. The attacks may initially be short-lived and milder, but if no remedy is provided to cure gout, they tend to become increasingly intense and long-lasting.
So, signs and symptoms of gout may come and go, but they almost always occur suddenly, often at night. These include:
- Severe joint pain. Gout usually affects the big toe, but can occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. The pain is likely to be most severe within the first four to 12 hours after it starts.
- Persistent discomfort. After the most severe pain goes away, some joint discomfort may remain, which may last for a few days or weeks. Later attacks are likely to last longer and affect more joints.
- Swelling and redness. Affected joints become swollen, tender, warm and red.
- Limited range of motion. As gout progresses, you may not be able to move your joints normally.
What causes gout flare ups in big toe?
When deposits of uric acid crystals build up in the joints as a result of high concentrations of uric acid in the blood (hyperuricaemia), it cause flare-ups (crises) of painful inflammation in and around the joints. As already said, gout usually affects the big toe, but can occur in any joint.
As we have seen, anyone at any age can suffer from gout but men and adult are more at risk. There are several factors that increase the likelihood of suffering from it:
- Having high levels of uric acid in the blood (above 6.8 mg/dl).
- Being obese or overweight.
- Taking certain drugs:
- Diuretics (some types more than others), as they reduce the amount of uric acid that passes in the urine, favouring its deposit in the form of crystals.
- Medicines containing a substance called salicylate. For example, aspirin.
- A vitamin called niacin (nicotinic acid).
- Cyclosporine, which is a medicine that blocks the immune system. It is used to treat some autoimmune diseases and to prevent organ rejection after transplantation.
- Levodopa, which is a drug used in the treatment of Parkinson’s disease.
- Some drugs used for the treatment of tuberculosis (tuberculostatics).
- Eating a diet rich in foods or substances that increase uric acid levels (foods rich in purines). These include some seafood, oily fish, red meat, beer (alcoholic and non-alcoholic), alcoholic beverages and soft drinks.
- Exposure to lead.
- Having any of the following diseases:
- Kidney failure.
- High blood pressure.
- Excess cholesterol and triglycerides in the blood (hyperlipidaemia).
- Hypothyroidism (slowing of thyroid gland function).
- Diabetes.
- Medical problems that cause cells to reproduce and be eliminated more quickly than usual, such as psoriasis, haemolytic anaemia and some types of cancer.
- Rare diseases in which the body does not properly regulate the concentration of uric acid in the blood due to enzyme deficiencies.
- Drinking alcohol.
- Having relatives with the disease, i.e. the genetic factor plays a role.
What to do for gout in big toe?
Because it is so annoying and painful, this disease diminishes and affects the quality of life of those who suffer from it, which is why we recommend that, when faced with the symptoms of gout, you take all the appropriate measures to eliminate excess uric acid from your body.
Treatment can be based on different types of medication and consists of reducing the pain of gout attacks, helping to prevent and avoid irreversible damage to the joints. The aim is to reduce the levels of uric acid in the blood, and for this it is important to take care of the diet and lifestyle by avoiding a sedentary lifestyle. It is important to eat a diet low in purines and reduced in salt to prevent the kidneys from working too hard.
The aim of lowering uric acid levels in the blood is to prevent uric acid from being deposited in the joints. It is based on diet and weight control, as well as pharmacological treatment (allopurinol, febuxostat or benzobromarone), which should be started once the acute gout flare-up has resolved. The level of uric acid in the blood should also be monitored regularly and the treatment prescribed by the doctor should not be abandoned.
To treat and prevent an acute attack of gout, you must reduce pain and inflammation. It is usually based on the administration of medication (anti-inflammatory drugs, colchicine or glucocorticoids), as well as resting the affected joint and applying cold to the area to relieve symptoms.
You also must watch your diet and eliminate all the foods mentioned above. You should also see your family doctor so that he or she can prescribe anti-inflammatories or whatever he or she deems appropriate to reduce the pain, as this is the most annoying aspect of this disease.
But there are also some foods and home remedies that you can add to the medical treatment and that have no side effects, such as cherry and pineapple juice, citrus juice, baking soda, banana, juniper oil, grapes: this fruit has a large amount of antioxidants, so it will be a good ally to combat and prevent gout. Likewise, it will also be very useful for relieving pain caused by rheumatoid arthritis, all you have to do is eat several grapes a day, apple cider vinegar,…
Of course, a good way to avoid having high uric acid is to take care of both your diet with a Mediterranean diet and exercise. We also recommend that once you have suffered from this ailment, you should measure your uric acid level to monitor your levels.
How long does gout attack in the big toe last?
Gout is a disease caused by an accumulation of monosodium urate crystals in various parts of the body, but mainly in the joints, soft tissues and kidneys. The acute attack of gout is the one that usually starts during the night and consists of an arthritis that causes severe pain and also redness in the metatarsophalangeal joint of the big toe. As a rule, gout attacks may initially be short-lived and mild, but if nothing is done to cure the disease, they can become increasingly severe and long-lasting.
An acute attack of gout lasts 3 to 10 days on average. Chronic gout occurs more frequently, but may be less severe.
Gout attacks vary in duration: some last only a few hours and others last several days. But in general, a gout attack usually gets better within 3 to 10 days. People who have had gout in the past may well have gout again after a few months or years. In addition, these repeated attacks may last longer and occur more often. If left untreated, gout is likely to progress and cause permanent joint pain and may damage the kidneys.
With proper treatment, your gout attack should go away in a few days. If left untreated, it can last for several days or weeks.
Talk to your doctor if you continue to have gout attacks. The more frequent they are, the longer they can last and the more joints they can affect. Your doctor may prescribe medicines to help prevent future gout attacks. These medications remove uric acid from your joints, reduce the level in your body and reduce swelling. Aspirin may interfere with the way these medications work. Work with your doctor on a treatment plan to control your gout. You may need routine visits to monitor your uric acid level.
What are the symptoms of gout in big toe?
On many occasions the joint at the base of the big toe is where the attack of gout usually originates, as we have seen, giving the sensation that it is on fire as the affected joint is hot (as if it were on fire), swollen and so sensitive that even the weight of the sheets or blanket cannot be supported. But what are the symptoms?
Typical symptoms involve severe pain in the joints of the foot and toes, along with redness, swelling, difficulty moving the joints and sometimes tophi (deposits of uric acid crystals in the form of firm, yellowish nodules). Symptoms usually appear suddenly and gout attacks are often recurrent.
It occurs as sudden episodes (attacks) of severe pain and swelling of a joint and is one of the causes of acute arthritis. The acute episode, without treatment, lasts for several days.
These episodes tend to recur and can affect any joint in successive attacks. The joint most frequently affected is the first metatarsophalangeal joint of the foot, but it can also occur in other joints of the feet, the ankles and, more rarely, the knees or wrists.
Occasionally, synovial bursae or tendons may become inflamed, leading to bursitis or tenosynovitis, respectively. If the disease is allowed to progress, the attacks may not resolve completely, affecting several joints at the same time and severely limiting the patient’s quality of life.
Sometimes, in advanced stages, palpable accumulations appear in the form of hard nodules, called tophi. Sometimes, uric acid crystals are deposited in the kidneys, leading to episodes of nephritic colic.
The symptoms of gout can be intermittent, although there are ways to control them and also to prevent exacerbations. As we said, it most commonly occurs at night and some of the main symptoms are:
- Severe joint pain in big toe.
- Persistent discomfort: After the internal pain goes away, some joint discomfort may still remain. This may last for a few days or weeks, and subsequent attacks are also likely to last much longer and affect other joints.
- Redness and swelling. The joints also become swollen, tender, warm and red.
- Functional disability and limited range of motion. As the gout or gout attack progresses, it is very likely that the individual will not be able to move the joints normally.
- Nephritic colic.
What triggers gout in big toe?
It is important to understand what triggers gout attacks so that you can reduce flare-ups in the future. Certain foods, medications, or behaviors can trigger gout attacks.
The following could trigger gout attacks: - Becoming dehydrated
- Do not take daily gout medications as prescribed
- Purines-rich foods
- A joint injury such as bumping your big one toe
- Consuming excessive alcohol
Sources
- Roddy E. (2011) – Revisiting the pathogenesis of podagra: why does gout target the foot?, J Foot Ankle Res. 2011; 4: 13., doi: 10.1186/1757-1146-4-13 | Publisher Site
- Solliman G. (2001) – A Balanced Approach of Gout Chronic Pain. Pain Management Medications. [online] 19(2). doi:8.14253/embr.191957762.
- Zanbom D. (1999) – Arthritis – National Center for Complementary and Integrative Health, Scientific Reports, [online] 8(3). doi:9.1237/s31596-019-76672-x.
- Lowfing V., Tangtang F., Zunmafr J., Kasten H. (2018) – Gout and Rheumatoid Arthritis: A Brief Overview of the Treatment, Journal of Integrative Medicine, [online] Volume 3, pp.142–163. doi:12.1145/jim.s1725.
- Bultock K. (2016) – What killer for inflammatory rheumatoid arthritis synovial fibroblasts, Therapeutics and Clinical Risk Management, [online] 12(4). doi:12.134/s31516-012-02897-2.
- Amsari D., Rais R. & Suttan Q. (2001) – Effect of natural supplementation on joint pain and recovery: a randomized controlled trial, Medical Principles and Practice, , [online] 2(1), p.131. doi:9.4203/0973-9475.101148.
- What are many Causes of Toe Pain? Do you suffer from toe pain? Are you not aware of the root cause? Are you unable to live your life to its fullest? Although most causes of pain in the toes are not serious, it can make your life miserable. Some pains can be obvious, such as an injury, but others may be completely undiagnosed. The symptoms can often be used to diagnose the cause of the pain. Most often, pain is felt in the big toe. This can cause difficulty walking even a few steps. Take Note Gout- This condition affects the big toe joint and causes it…
- Why does my Big Toe Hurt? Toe pain? There are many reasons you might experience toe pain. It is important to determine the cause so that you can fix or control the problem. Here are some possible causes and treatments. The joint of the big foot is the most common site for arthritis in the foot. Arthritis is a condition that causes inflammation of the cartilage, lining, and bones of the body. It can cause redness, warmth and swelling. To push off every step, your big toe must be present. If this joint becomes stiffened, it can make walking difficult. Gout is a type of arthritis…
- Why is my Big Toe Swollen and Hurting? Is your big toe hurting? It was cold outside and you were sleeping soundly when suddenly your feet felt numb. You were shocked to discover that your big toe was swollen and hurting badly when you turned on the light. You crawled to the medicine cabinet in the hope that the pain would go away once you have taken some aspirin. You rolled around on the bed all night trying to endure the pain, while flashing back to your past and wondering what caused the painful swelling of your big toe. Pain Factor The pain can be unbearable if you're…
1 Comment
Dany
Thanks to this information I understood what was wrong with me, I really have the symptoms of gout in my big toe. It is just as described in the info, it is such a strong burning that it does not let me sleep several nights. I did not know what was the cause of my problem, now I know that nutrition is vital to alleviate these intense pains. Excellent information, thanks for sharing it with everyone!