When you think of pain in your big toe joint, you may think of injury or overuse as the culprit, but there may be another cause - it could be a condition called gouty arthropathy, or gout, for short.  Gout is actually a type of arthritis.  It can cause an acute attack in any joint, but most commonly, it occurs in the big toe joint.  It is accompanied by sudden onset of pain and stiffness, sometimes redness and warmth in the joint. It most commonly occurs in men. 

Gout is caused by an increase of uric acid concentration in the blood.  This may happen due to your body either overproducing uric acid, or under excreting the uric acid produced.  High levels of uric acid may go undetected in your body and have no effects, however sometimes high uric acid levels may cause gouty crystals to form in the joints and cause swelling and pain. High uric acid levels may come from eating certain foods, such as a higher than normal protein diet, drinking excess alcohol, or even some medications such as certain diuretics. 

The most common symptoms of a gout attack is a sudden onset of pain and tenderness to the foot with the common description that the pain is so bad that "even the bedsheets touching the foot is intolerable." Gout attacks usually happen at nighttime and do not correlate with any trauma or injury.  Gouty arthropathy can occur in other joints such as the knee or ankle, but most commonly occur in the big toe joint of the foot.  It is diagnosed after an exam by your doctor, and can be confirmed with aspiration of the joint which may reveal "gouty tophi," or gout crystals, that can be seen under a microscope.  Often times a blood test or urine collection test can reveal increased levels of uric acid in the blood that can also help in diagnosis.  

Treatment of gout can consist of a local injection of corticosteroid into the foot, or an oral steroid, or other strong oral anti inflammatory along with other oral medications taken under special instruction.  Rest, immobilization, and elevation will also help.  The sooner you start treatment of gout during an acute attack the sooner you will feel pain relief.  If you are seen by a doctor within 24 hours, you can start treatment and feel relief within the next 24-48 hours.   So don't wait... If you think you may have a gout attack, call our office and we will be able to diagnose your pain and help you feel relief.