Gout of the Foot & Ankle

Gout is a common form of arthritis affecting the foot. Gout attacks are due to precipitation and collection of excess uric acid which forms crystals within the joints. Some patients can have high uric acid in their bodies without ever having a gout attack but some can have attacks with minimal increases in uric acid levels. The joint most commonly affected is the big toe joint but other joints can be involved as well.


Patients present with a sudden onset of sharp pain accompanied by a red, hot swollen and tender joint. The pain is so severe that it can wake patients up from their sleep. Pain is worse with ambulation and even light touch can be unbearable at times.

Gout can affect anyone but men are three times more likely to be affected than women. Women tend to have gout attacks after menopause. Risk factors include obesity, heart failure, diabetes, family history of hout, high blood pressure and kidney disease. Certain medications can also precipitate gout attacks, e.g, water pills. Certain diets are also complicit in precipitating attacks. Patients who consume diets with high animal proteins on a regular basis can be affected. Chronic alcohol use is also a known risk factor.

Diagnosis is clinical but X-rays are often taken to rule out other causes. Chronic gout also has subtle X-ray traits that can be identified. Peri joint erosion and cyst formation is common. Treatment initially is to decrease pain and long term the goal is to prevent recurrence. Medications such as colchicine, indomethacin and medrol dose packs are utilized to treat acute events. Prevention can be achieved by drugs such as allopurinol, febuxostat and probenecid. Newer medications such as KRYSTEXXA are reserved for chronic gout. A referral to rheumatology is also warranted.

Surgical intervention is often required when the big toe is severely arthritic. This usually requires an arthrodesis of the 1st MPJ.


Please see our expert doctors if you are suffering from gout for either conservative or surgical treatments