Written By: Chloe Wilson BSc(Hons) Physiotherapy
Reviewed By: FPE Medical Review Board
Foot gout is a common problem and is characterised by sudden intense pain, often starting at night with no warning.
Classic foot gout symptoms are localised pain, swelling, redness, heat and tenderness.
Gout in foot most commonly occurs in the big toe but can affect other parts of the foot and ankle.
Here we will look at what is going on during foot gout attacks, common symptoms and diagnosis tools, risk factors and treatment options, and then go on to look at the best gout prevention strategies for avoiding flare-ups.
Foot gout is caused by a build-up of uric acid crystals in a joint. Uric acid is a natural product that is constantly being produced when the body breaks down chemicals known as purines found in foods such as meat and seafood.
Normally, uric acid is filtered and removed through the kidneys and doesn’t cause any problems. However, sometimes the kidneys can’t remove the uric acid quickly enough or the body just produces too much of it.
Over time, this leads to the formation of sodium urate crystals, usually around one of the joints in the body. The tiny crystals are shaped like hard, spiked rods.
Initially, there are no obvious gout symptoms, but as more crystals accumulate (which may take years), they can start to cause problems. If these crystals enter the joint, they irritate the joint lining, triggering an inflammatory reaction, causing intense pain, redness and swelling around the joint.
Gout in foot most commonly occurs at the base of the big toe, known as the metatarsophalangeal joint. Gout affecting the big toe accounts for over 50% of cases of the disease and is also known as Podagra. It is one of the most common causes of toe pain and is the most common type of inflammatory arthritis.
The most common symptoms of foot and ankle gout are:
In severe cases, foot gout symptoms may also include fatigue and a fever.
Symptoms from gout in foot often start suddenly and progress rapidly over a few hours, particularly at night-time. This is thought to be due to people having a slightly lower body temperature at night.
Gout symptoms usually last between five and ten days but it can take longer for symptoms to subside completely.
Gout tends to affect the extremities and Podagra, where it affects the big toe is the most common place to get symptoms of the disease, but people can also suffer from ankle gout or even further up the leg with gout knee.
The upper limbs may also be affected, most commonly the fingers, wrists and elbows. It is thought gouty arthritis most commonly occurs in the extremities as they tend to be the coldest parts of the body, which increases the risk of sodium urate crystal formation.
There are essentially three phases of Gout that sufferers cycle through:
Phase 1: Flare Up
Sudden onset of gout symptoms. Initial flare ups tend to only occur in one joint, but over time, recurrent flare ups often affect more than one joint at a time
Phase 2: Intercritical Gout
This is the period between flare ups when people are symptom free. Some people will only have one episode of gout but over 60% of sufferers will experience a repeat attack within one year. Over time, the frequency of foot gout attacks may increase
Phase 3: Tophaceous Gout
People who suffer from recurrent episodes of gout, or who have high levels of uric acid for a number of years, often acumulate a large number of urate crystals which form lumps or masses known as "Tophi". Tophaceous gout can cause bone damage as the tophi erode bone and cartilage. Whilst tophi tend not to be painful themselves, they can get inflamed and people are often distressed by their appearance.
Whilst gout foot flare ups often happen for no particular reason, there are a number of factors that have been linked to an increased risk of gout:
Accurate foot gout diagnosis starts with the doctor asking questions about your symptoms such as when and how they started, previous episodes, diet and any family history of the disease.
Gout may be
suspected from your history but with over two hundred other types of arthritis,
your doctor may carry out further tests to ensure an accurate gout
diagnosis. This may involve:
Foot gout treatment aims to reduce the pain associated with the flare up and lower uric acid levels to prevent further attacks by a combination of:
Foot gout treatment often starts with medications and there are a few different types that can help:
Always check with your doctor or pharmacist before taking any new medication
Many people find great relief from foot gout by using supplements to reduce uric acid levels. There are a number of different types available that can help to reduce both the frequency and intensity of flare ups. You should always check with your doctor before taking any supplements. Find out more about gout supplements
Ice therapy can help reduce the pain and inflammation associated with flare ups and often people find it very soothing. But it is really important to use ice correctly otherwise it can make foot gout worse. Visit the Ice Treatment section for advice on how to use ice safely and effectively.
As with most things, prevention is better than cure. There are a number of things you can do to reduce the risk of a gout attack which we look at in detail in the Gout Prevention section. You'll find loads of top tips on things like diet, exercises and life style changes.
Whilst podagra is one of the most common causes of big toe pain, there are a number of other things that it could be - visit the Toe Pain section for help working out what is wrong.
You may also be interested in the following articles:
Foot gout is a common type of arthritis caused by high urate levels. Uric acid crystals invade toe joints causing intense toe pain, swelling, redness and heat to develop rapidly, usually at night.
Gout foot treatment and prevention aims to reduce urate levels through a combination of medication, dietary changes, and lifestyle modification.
Side Foot Pain
May 17, 2022
January 27, 2023
September 28, 2022
Page Last Updated: 02/28/23
Next Review Due: 02/28/25