Gout and Your Feet

Dr. Vincent Giacalone

Dr. Vincent Giacalone

Podiatric Medicine & Surgery

466 Hook Rd., Suite 24D, Emerson, NJ 07630

Phone: 201-261-0500

Gout and Your Feet

What is Gout?

Gout is a form of arthritis that occurs as a result of the build-up of uric acid in the body, specifically in the joint fluid. Normally, uric acid is dissolved in the blood and passed through the kidneys into the urine, where it is eliminated. If the body increases its production of uric acid or if the kidneys do not eliminate enough uric acid from the body or we eat too much food which contains increased amounts of a protein called purine, levels of uric acid build up in the blood (a condition called hyperuricemia) and in the joint. This accumulation of uric acid typically occurs when the body has difficulty processing and eliminating a certain type of protein called purines (PURE-EENS) that are found naturally in our diets.

What are the Symptoms of Gout?

Gout usually starts with a sudden onset of intense pain in one or more joints, usually the big toe joint of the foot, however can occur in any joint.  The pain is accompanied by redness, swelling and warmth over the joint. Many patients say they first noticed pain in the middle of the night or upon rising in the morning. Other common sites are the instep of the foot, the ankle, or the knee. When the foot is involved, wearing shoes is difficult and painful, as are attempts to move the joint or stand on the foot.

What Causes Gout?

A number of risk factors are related to the development of hyperuricemia and gout:

Genetics may play a role in gout, since up to 18 percent of people with gout have a family history.

Gender and age are related to the risk of developing gout; it is more common in men than in women and more common in adults than in children.

Being overweight increases the risk of developing hyperuricemia and gout because there is more tissue available for turnover or breakdown, which leads to excess uric acid production.

Alcohol can cause hyperuricemia because it interferes with the removal of uric acid from the body.

Eating too many foods rich in purines can cause or aggravate gout in some people. Foods such as: liver, kidneys, tripe, heart, tongue, excessive amounts of red meat and poultry, shellfish, mussels, anchovies, fish roe, herring, mackerel, sardines, shrimp, and scallops, peas, legumes, spinach, lentils and beans, yeast, mushrooms and asparagus.

An enzyme defect that interferes with the way the body breaks down purines causes gout in a small number of people, many of whom have a family history of gout.

Exposure to lead in the environment can cause gout.

Some people who take certain medicines or have conditions which places them at risk for having high levels of uric acid in their body. The following medicines can lead to hyperuricemia as they reduce the body’s ability to remove uric acid:

Diuretics, or water pills, which are taken to eliminate excess fluid from the body in conditions like high blood pressure, edema, and heart disease, decrease the amount of uric acid passed in the urine.

Salicylates or anti-inflammatory medicines made from salicylic acid, such as aspirin.

The vitamin niacin, also called nicotinic acid.

Cyclosporine, a medicine used to suppress the body’s immune system (the system that protects the body from infection and disease) and control the body’s rejection of transplanted organs.

Levodopa, a medicine used to support communication along nerve pathways in the treatment of Parkinson’s disease.

Who Is Likely To Develop Gout?

Gout occurs in approximately 84 out of every 10,000 people. It is rare in children and young adults. Adult men, particularly those between the ages of 40 and 50, are more likely to develop gout than women, who rarely develop the disorder before menopause. People who have had an organ transplant are more susceptible to gout.

How is Gout Diagnosed?

The diagnosis is based on a personal and family history, as well as on Dr. Giacalone’s examination which often finds the classic signs of gout and makes the diagnosis clear. Blood tests may be performed to determine uric acid levels. Sometimes the joint fluid is examined to look for uric acid crystals under a microscope. X-rays also may be performed to examine both the bones and joints to rule out abnormal changes associated with gout.

How is Gout Treated?

Gout can be treated with one or a combination of therapies. The goals of treatment is to ease the pain associated with acute attacks, to prevent future attacks, and to avoid the formation of tophi (joint damage) and kidney stones. The treatment of gout starts with establishing the correct diagnosis. Prescription oral anti-inflammatory medications or oral cortisone medication are most often used to manage the acute attack. While over the counter drugs may reduce symptoms, they are rarely strong enough to treat the acute pain, swelling and inflammation. When anti-inflammatory medications or steroids do not control symptoms, Dr. Giacalone may consider using a medication called colchicine. This drug is most effective when taken within the first 12 hours of an acute attack. Dr. Giacalone may ask patients to take oral colchicine as often as every hour until joint symptoms begin to improve or side effects such as nausea, vomiting, abdominal cramps, or diarrhea make it uncomfortable to continue the drug.

For some patients, Dr. Giacalone may prescribe either anti-inflammatory medication or oral colchicine in small daily doses to prevent future attacks. He may consider prescribing medicine such as allopurinol (Zyloprim) or probenecid (Benemid) to treat hyperuricemia and reduce the frequency of sudden attacks and the development of tophi. Gout often can be controlled with proper medication, both when there is an attack and on a long-term basis. It is important to establish which of the two primary causes (producing too much uric acid or not eliminating it properly) is involved in order to treat the gout with the appropriate medication. If the gout attack is in the toe or foot, it will typically help to elevate the foot, avoid standing and walking, and wear only a loose slipper until the pain reduces.

If gout attacks continue despite medical treatment, if there are excessive deposits of gouty crystals within a joint, or if arthritis causes continual discomfort, surgical treatment may be necessary to remove the crystals (tophi) and repair the joint. Natural remedies, including apple cider vinegar, cherry juice, omega-3 fatty acids, cod liver oil, boswellia, celery seeds and berries such as strawberries, blueberries and goji berries have been noted to help. See the recipe for apple cider vinegar on the last page.

How can Gout be Prevented?

As outlined above, certain foods that are high in purines can increase uric acid levels and thus bring on an acute attack of gout. These foods include red meats, shellfish, beer, red wine and salt. Some medications, such as diuretics (water pills) that are often used to control high blood pressure or reduce swelling, also may cause an acute attack of gout. Stress, infection, and trauma also are possible causes.

Drinking 6-8 glasses of water each day, eating an appropriate diet, and evaluating current medications will reduce the likelihood of an attack or lessen the severity should it occur. If you have a personal or family history of gout, regular examinations by Dr. Giacalone also will reduce the potential for an attack.

Dr. Giacalone has been trained specifically and extensively in the diagnosis and surgical treatment of foot disorders.  Dr. Giacalone has been board certified by The American Board of Podiatric Surgery since 1995 and is a Fellow of the American College of Foot and Ankle Surgeons. He recently practiced at the Hospital for Joint Diseases in New York City.  Dr. Giacalone performs surgery at Hackensack University Medical Center (HUMC) in Hackensack, HUMC @ Pascack Valley in Westwood and Surgicare Surgical Center in Oradell.

THE RECIPE

  • 1 Tablespoon of Honey
  • 1 Tablespoon DISTILLED WATER
  • 1 Tablespoon of Apple Cider Vinegar (make sure the Vinegar has its “Mother” in it, this is the naturally occurring strand-like enzymes of connected protein molecules formed when converting alcohol into Vinegar… its organic structure is beneficial, plus this generally is only in Organic, non pasteurized non fermented brews.) 
  • Mix them together and drink.
  • Take this twice a day after meals and see the benefits in a week.
  • If you want you can add more water.
  • I have also used warm water to help melt the honey and generally I use organic honey.
  • It can be quite thick, and you can change the recipe and lower the honey to a teaspoon’s worth if you want.
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       Here is a smaller version :

  • 250 mL (8 oz) Purified Water (warm enough to melt honey)
  • 1 to 2 teaspoons Raw Apple Cider Vinegar (Organic recommended)
  • 1 to 2 teaspoons Honey (Local, raw, non-GMO recommended)