Gout

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Sudden, painful swelling in the big toe, foot, or ankle? We diagnose and treat gout flares, rule out infection, and help prevent recurrences—so you can get back on your feet.

Gout is an inflammatory arthritis caused by uric acid crystal buildup inside a joint. It most often affects the big toe joint, but can involve the midfoot, ankle, or other toes. Flares usually start suddenly at night or early morning with severe pain, redness, warmth, and swelling.

Common symptoms

• Sudden, intense pain in the big toe, midfoot, or ankle
• Redness, warmth, marked tenderness (even sheets can hurt)
• Swelling and limited motion
• Flares that remit, then recur

Why it happens (risk factors)

• Elevated uric acid (genetics, reduced kidney clearance)
• Dehydration, high-purine diet (certain meats/seafood), alcohol (especially beer/spirits)
• Diuretics and some other medications
• Obesity, metabolic syndrome, kidney disease

We start with a focused history and exam to confirm a gout pattern and to rule out other causes like infection or fracture.

• X-rays help assess joint changes and exclude other problems.
• Ultrasound can show features suggestive of crystal deposition.
• If needed, we coordinate joint aspiration for crystal analysis and infection rule-out.
  We also review your medications, hydration, diet, and prior flares.

Most flares improve quickly with a clear, stepwise plan.

During an acute flare

• Anti-inflammatory medicines (as appropriate for your health history)
• Colchicine or a short course of corticosteroids in selected cases
• Rest, elevation, and ice; offload with a post-op shoe or boot if walking is very painful
• Supportive footwear once pain settles
  If you already take a urate-lowering medication (e.g., allopurinol), don’t stop it during a flare; we coordinate with your primary care doctor or rheumatologist for any long-term adjustments.

Preventing recurrences

• Hydration and targeted diet guidance (moderate alcohol; limit high-purine triggers if they affect you)
• Review of contributing medications with your medical team
• Consider urate-lowering therapy via your primary care doctor/rheumatologist when flares recur or uric acid stays high
• Shoe and insert advice to protect tender joints during activity

1. Evaluation: Exam, imaging if needed, and a review of your flare history and triggers.
2. Plan: Same-day pain and swelling plan, footwear/offloading guidance, and clear next steps.
3. Follow-up: Recheck to ensure the flare resolves and to discuss prevention and referrals if indicated.

• Hot, very painful joint with fever or chills (possible infection)
• Inability to bear weight or concern for fracture after an injury
• Diabetes or poor circulation with spreading redness or an open wound
• Severe pain not improving with the initial plan

• Thoughtful diagnosis to distinguish gout from infection or injury
• Clear, practical plans for fast pain relief and safer activity
• Coordination with your primary care doctor/rheumatologist for long-term prevention
• Footwear and orthotic guidance to reduce joint stress

How long does a gout flare last?
With prompt treatment, many flares improve over 24–72 hours, though swelling can take longer to settle.

Will diet changes alone fix it?
Diet and hydration help, but some people still need urate-lowering medication. We’ll coordinate with your medical team.

Is it always the big toe?
Often, but gout can affect the midfoot and ankle too—especially with recurrent disease.

Can I keep exercising?
During a flare, reduce load and protect the joint. We’ll outline when and how to return to activity.

Let’s calm the pain now and build a plan to lower your risk of the next one.