Friday, July 19, 2013

What you should know about Gout in the foot and ankle

Have you ever suffered from a painful and swollen joint in your foot or ankle?  Has this pain persisted despite taking antibiotics and anti-inflammatory medications?  Have you had multiple episodes of this pain?  If so, then you may be one of 8.5 million Americans who suffer from gout each year (1).

Prevalence of Gout has been increasing in recent years and it is currently one of the most common causes of inflammatory arthritis in industrialized countries.  Factors that contribute to this condition include increased lifespan, dietary habits, renal and cardiovascular disease, alcohol consumption, and prescribed drugs that may raise serum uric acid levels (2).

Gout results from the deposition of uric acid crystals in a joint, resulting in acute inflammatory response.  If left untreated, chronic gouty arthropathy can develop and progress into deposition of uric acid crystals and tophi in soft tissues.  In the foot and ankle, Gout is most commonly manifested in the great toe joint.

Current treatment guidelines:
  • Non-Steroidal Anti-inflammatory medications (NSAIDS) or corticosteriods in the acute phase
  • Uric acid Lowering Treatments (ULT), i.e. Allopurinol, for maintenance
  • Shoe gear modification – wider, supportive shoes with insoles
  • Custom Orthotics – accommodations to restrict motion of the affected joints
  • Ankle Foot Orthoses (AFO) – restrict motion of the ankle joint (if affected) to limit inflammatory response
  • Vitamin supplementation
  • Surgical reconstruction – reserved for failed conservative and pharmaceutical therapies

If you suffer from gout or symptoms resembling gout, then consult with your foot and ankle specialist for work-up and management.

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