At least twice a month, a patient will limp into my surgery with a very painful, inflamed big toe and the cause will be gout.

Gout is a form of arthritis that arises due to an imbalance of uric acid in the body. Excess uric acid travels in the blood and deposits as tiny crystals, usually in joints. This will lead to severe pain, redness and swelling. This acid is a waste product made by all of us and is excreted via the kidneys. When we produce too much, we are susceptible to developing gout.

Most patients tend to be middle-aged males and post- menopausal women. Typically, the patient will wake up in the middle of the night with an acute throbbing and swollen big toe. They will find it hard to walk and probably can’t wear a shoe. Usually only one joint is affected at a time but be mindful that any joint in the body can be affected.

Symptoms appear at their worst between 6 and 24 hours from onset and then slowly subside. An attack of gout can last up to 10 days. After this time the joint will start to look and feel normal again and the pain should completely disappear. Unfortunately almost everyone who has suffered an episode of gout will have attacks in the future.

RISK FACTORS

1. Alcohol and a diet high in purine-rich foods e.g offal, red meat, seafood, spirits, beer.

2. Obesity

3. High blood pressure

4. Diabetes

5. Family history of gout.

6. Gender; men are 4 times more likely to be have gout.

7. Age; over 45

TREATMENT

The goal in treating gout is to relieve the symptoms and prevent further attacks. Relief is given in the form of Non-Steroidal Anti- Inflammatory Drugs (NSAIDs) and these are prescribed. To prevent further attacks medication such as Allopurinol help to lower the levels of uric acid. Patients are advised to elevate the foot as much as possible and to use an ice pack to help reduce the swelling while waiting for the medication to take effect. A Podiatrist can make the patient orthotic devices to wear within the shoe to redistribute the pressure away from the affected area. Lifestyle changes such as weight loss and dietary adjustments are essential.

HOME REMEDIES

Add 1 tablespoon of apple cider vinegar to a glass of water and drink this 3 times a day.

Mix the juice of one lemon with 1/2 a tablespoon of baking soda. Leave this mixture for a few seconds then add a glass of water and drink.

Eat 15-20 cherries a day.

Eat bananas.

Use ginger in your food.

Increase your daily water intake.

Limit food sweetened with fructose.

Untreated gout and people who have had repeated attacks for over 10 years may develop GOUTY TOPHI. Here crystals are deposited in soft tissues like the earlobes and fingers. High levels of uric acid can also lead to kidneys stones and permanent joint damage so I strongly advise that you control your weight and diet to keep these risks to a minimum.

Angela Davis BSc (Hons) DPodM MChS is a podiatrist with offices in Montego Bay (293-7119), Mandeville (962-2100), Ocho Rios (974-6339), and Savanna-la-Mar (955-3154). She is a member of the Health and Care Professions Council in the United Kingdom.