“I don’t remember doing a thing to my foot; I didn’t stub it, I didn’t drop anything on it, but holy cow it feels like a boil in my big toe. I woke up and it’s big and red and throbbing. What do you think is going on with it?”
Indeed the base of Mr. Stoddard’s big toe was swollen, red and very tender to touch or put weight on. In the end, it turned out to be the age-old malady, gout. Gout was first identified by the Egyptians over four thousand years ago and then was recognized by Hippocrates in the fifth century BC and referred to as “the unwalkable disease”.
Gout is caused by uric acid crystals which precipitate out in joints. In up to 90% of individuals with gout, the base of the big toe is involved. However, other joints such as the wrist, ankle, fingers, knees and elbows may be involved. Also, another similar condition, often called pseudogout and caused by calcium phosphate crystals, can cause very similar symptoms.
Besides a red, painful, warm joint, gout can sometimes produce a low-grade fever and occasionally involves tophi which are deposits of uric acid crystals in the soft tissues of the ears, fingers, toes, or other joints. Over time, especially if untreated, gout can ravage joints and can damage other organs such as the kidneys.
Why does someone get gout? Like with most illnesses, it starts with a built-in genetic tendency. Add to that certain foods and drink. Gout used to be called the rich man’s disease because it was mostly the rich who could afford the food and drink which triggered a gout attack. Traditionally, large meals of meat and beer are considered a common trigger for gout. The reason is that these kinds of meals cause a spike in uric acid levels which then precipitate out in a joint causing the pain, redness and swelling. But other foods such as high fructose corn syrup, seafood such as shrimp and scallops, sugary drinks, and organ meats such as liver are also potential triggers for gout. Also, certain medicines, such as diuretics, and certain conditions such as obesity and cancer will also increase the likelihood of gout attacks.
Gout is not uncommon, affecting about 4% of the adult population. Pseudogout, officially named calcium pyrophosphate disease (CPPD), affects a higher and higher percentage of individuals the older they get.
So, if you ever awaken with a painful, red base of your big toe, or perhaps some other joint, with no recollection of an injury, what should you do? The pain is usually enough to motivate you to head to your doctor. The diagnosis can generally be made by the clinical appearance, usually with a little help from blood work. Less commonly x-rays may be obtained. The definitive test is aspirating fluid from the painful joint and sending it for analysis to see if crystals can be identified. Because this is often very painful and difficult, especially if the joint is a toe joint, it is done somewhat infrequently.
Once the diagnosis has been established, anti-inflammitant medicines such as steroids, colchicine, or non-steroidal anti-inflammitants are prescribed. If a person has repeated episodes of gout, preventive medicines such as allopurinol or probenecid may be used to ward off future painful attacks.
Reading some of the accounts of individuals struggling with painful gout over decades in the days prior to effective medicines makes you thankful for the many available treatments today. So if gout or pseudogout looks like it has attacked you, get it checked out and fight back.