Mark Suttie, one of our physiotherapy team at Blackberry Clinic Milton Keynes, had to seek some advice and investigations regarding an acutely painful toe. He was interested to hear that it potentially could be gout causing his pain. It is important to get an accurate diagnosis for your pain, and our therapists and doctors will consider all potential causes when they are taking a history and examining you. The history and physical examination may often lead to diagnosis but if the picture is not clear they are trained to consider causes that may not be musculoskeletal in origin. Read Mark’s blog below about his experience of trying to get an accurate diagnosis for his acute toe pain and the research he did to learn more about gout.
What is Gout?
After recently developing some very acute toe pain, one of the potential reasons suggested was that I was suffering from gout. Gout is generally perceived as an old-fashioned disease that doesn’t really affect people these days. Even as an experienced Physio, it’s something I haven’t seen very often and didn’t know much about. Cue some research to find out what was going on! As it turns out, gout is becoming more and more common and so I thought I’d share what I’d found so that you have more information if you ever experience similar symptoms.
Just the name “gout” makes it sound old fashioned but it’s actually an increasingly common type of inflammatory arthritis. It usually effects the big toe joint by causing pain, swelling, heat and red skin. It will likely just appear without any injury. There are risk factors for it developing though shown below. It can sometimes affect other joints too. Once it appears, a flare up can last for a few weeks and then can disappear for a few weeks or even longer, up to years, before it comes back. The risk factors and how you manage it usually determine how long you can be without it. There is no cure for gout so managing the risk factors and using medication are the best course of treatment.
Hyperuricemia is the underlying condition that causes gout. This is a condition where there is too much uric acid in the body. Uric acid is a substance that your body produces to break down purines which occur naturally in the body and are also found in food/drink that you consume. So if your body has a high purine number, usually through diet, then too much uric acid will be created. This excess uric acid crystallises in the joints, usually the big toe, and this is what causes the pain, swelling and stiffness. It’s important to note that it’s possible to have hyperuricemia without it causing gout and does not need to be treated in this case.
The risk factors for developing gout include:
· Male (increasing as you get older)
· Overweight
· High alcohol consumption
· Certain medicines e.g. diuretics, high blood pressure
· High cholesterol, high blood pressure, kidney problems, osteoarthritis, diabetes
A gout attack can be triggered by:
· Illness with high temperature
· High alcohol and fat diet
· Dehydration
· Joint injury
If you do develop gout then management of these risk factors is important to prevent attacks occurring. Losing weight, eating a low purine diet and managing other health problems can all help to prevent attacks. If you do have an attack, seeing your GP urgently and taking gout medication is the best way to settle it. Rest and ice can also help to alleviate symptoms.
Gout is diagnosed by a GP and is usually confirmed with a blood test to detect how much uric acid is in the blood. It is worth noting that during a flare up, uric acid in the blood can sometimes appear normal as the excess has crystallised in the joint. So it is worth having a repeat blood test when you are not in a flare up to see if your usual levels are high. Gout can be confused with infection as they have very similar symptoms. This is why it is very important to see your GP as you may need
antibiotics if it is an infection and not gout. This was the case with my toe but I am awaiting the results of my follow up blood test to confirm that it wasn’t gout.
In summary, if you fit the risk factors, then be aware that gout is something that could develop so take a look at ways that can reduce the chances of this happening.
Mark Suttie
Physiotherapist
Blackberry Clinic Milton Keynes
