What Causes Ankle Gout
Gout occurs due to the accumulation of urate crystals in the joint, causing inflammation and intense pain. These crystals can form when you have high uric acid in the blood . Your body innately produces uric acid when it breaks down purines-substances that are found naturally in the body, as well as in certain foods, such as steak, organ meats, and seafood. Other foods that promote higher levels of uric acid include alcoholic beverages and drinks sweetened with fructose .
In a normal individual without gout, uric acid dissolves in the blood and passes through the kidneys to be expelled in the urine. But sometimes, the body produces too much uric acid, or the kidneys excrete too little of it. When this happens, uric acid can build up, forming sharp, needle-like urate crystals that become deposited in a joint or surrounding tissue causing pain, inflammation, and swelling.
Uric acid crystals tend to form in cooler temperatures, which is why they tend to form in the distal extremities, such as the hands and feet, which have a higher likelihood of becoming colder than the rest of the body.
Possible medical and health triggers of gout include:
Symptoms tend to recur anywhere from six months to two years after the initial episode, with approximately 60 percent of gout patients having a recurrence within one year.
Gout In The Ankle Symptoms & Treatment
The onset of pain in the ankle joint pain is usually at night when the body temperature is lower. Many times it is accompanied by fever and fatigue.
The attack usually lasts for 3 to 10 days when treated properly and in 50% of cases it recurs within a year. If ankle gout is ignored and not treated properly the number of urate crystals increases damaging the joint and soft tissues around it. Eventually, tophi nodules are formed and slowly kidney failure also takes place.
When Is Surgery Considered For Gout
The question of surgery for gout most commonly comes up when a patient has a large clump of urate crystals , which is causing problems. This may be if the tophus is on the bottom of the foot, and the person has difficulty walking on it, or on the side of the foot making it hard to wear shoes. An especially difficult problem is when the urate crystals inside the tophus break out to the skin surface. This then can allow bacteria a point of entry, which can lead to infection, which could even track back to the bone. Whenever possible, however, we try to avoid surgery to remove tophi. The problem is that the crystals are often extensive, and track back to the bone, so there is not a good healing surface once the tophus is removed. In some rare cases, such as when a tophus is infected or when its location is causing major disability, surgical removal may be considered.
Since it is hard to heal the skin after a tophus is removed, a skin graft may be needed. For this reason, we often try hard to manage the tophus medically. If we give high doses of medication to lower the urate level, such as allopurinol, over time the tophus will gradually reabsorb. In severe cases, we may consider using the intravenous medication pegloticase , since it lowers the urate level the most dramatically, and can lead to the fastest shrinkage of the tophus.
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Causes Symptoms And Treatment Options For Gout Of The Ankle
Weve discussed gout of the toe joints on the blog in the past, but thats not the only area of your body that can be affected by this inflammatory condition. In fact, another common location for gout problems is in your ankle joint. Below, we take a closer look at why gout develops in the ankle and how you can best treat the condition.
Symptoms Of Ankle Gout
Doctors can sometimes misdiagnose gout in the ankles as a variety of other illnesses like a sprained ankle or cellulitis. But there are a few symptoms that Frisco patients can look for that could indicate its actually gout.
Pain While a sprained ankle may be tender, gout is usually extremely painful. Many patients find it difficult to even walk during a gout attack.
Stiffness Many patients report that their ankle joint will become stiff when a gout attack is setting in. It may start with a dull ache that turns into severe stiffness.
Color Joint affected by gout will almost always be very red, often a very bright red.
Swelling Of course, another symptom of gout is intense swelling at the joint.
Texture Another telltale sign of gout is that the skin will be shiny.
Temperature With gout, the ankle joint will be very warm to the touch.
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The Role Of Medication In Prevention Of Gout
Table 3: Medications to pevent attacks of gout
Standard medications in preventing gout attacks
i. Colchicine : using the matches analogy discussed above1, using colchicine can be seen as dampening the uric acid matches. Colchicine does not lower the bodys store of uric acid, but it decreases the intensity of the bodys inflammatory reaction to these crystals. Recent studies have shown that at least one mechanism of colchicines action is by acting to prevent a cascade of reactions that lead to the production of interleukin 1-beta, which is an inflammatory protein , which is important in gouty inflammation.8
ii. Allopurinol: This agent is presently the most commonly used drug for the prevention of gout. Allopurinol blocks the enzyme xanthine oxidase, which blocks the breakdown of purines, thus decreasing the bodys total amount of uric acid. Allopurinol is effective in preventing gout no matter what the mechanism of the elevated uric acid was. Whether a person is making too much uric acid, or has difficulty excreting it via the kidney, allopurinols decrease in uric acid production leads to the same goal: a decreased total body uric acid.
Table 4: Reasons to use medication to lower uric acid
What Are The Signs And Symptoms Of Gout
Gout flares start suddenly and can last days or weeks. These flares are followed by long periods of remissionweeks, months, or yearswithout symptoms before another flare begins. Gout usually occurs in only one joint at a time. It is often found in the big toe. Along with the big toe, joints that are commonly affected are the lesser toe joints, the ankle, and the knee.
Symptoms in the affected joint may include:
- Pain, usually intense
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What Are The Symptoms Of Gout In The Ankle
The main symptom of gout in the ankle is pain and discomfort in the surrounding area. Keep in mind that gout is often unpredictable, regardless of the joint its affecting. You might go weeks or even months without any symptoms, only to wake up with a burning pain in your ankle.
In some cases, gout starts out in one of your big toes before moving on to other areas, such as your ankle. Over time, these flare-ups may last longer than they previously did.
Other symptoms you might feel from gout in your ankle include:
Gout In Ankle: Causes Symptoms Treatment And Prevention
Gout in the ankle or ankle gout is an inflammatory condition of the joint leading to swelling, pain, and redness of the ankle. Gout is a complex form of arthritis that can affect anyone, with over eight million Americans suffering from the condition today. Men are typically affected more, but postmenopausal women become increasingly susceptible in their later years.
The most common joint affected by gout is the big toe, but joint pain may also be experienced in the knees, hands, ankles, and wrists. Having gout in the ankle can be very debilitating as it encumbers your ability to walk normally.
This article will answer the question what causes gout in the ankle, giving you a better understanding of the intricacies of the condition to better treat it.
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Preventing Future Ankle Gout Symptoms
After surviving an arduous bout of gout ankle, keeping the body in a state of greater health by keeping the body chemistry on the more alkaline side is wise. Minimizing the causes of gout can be done in several ways:
- Strong breathing awareness and habits keep the blood healthy and oxygenated
- Maintaining consistent hydration is essential for proper pH balance
- A diet of alkalizing foods, and foods that support strong kidney and liver function is fundamental
- Managing stress is important for minimizing the effects of acid-forming hormones in the inner terrain
- Consistent exercise and sleep are the basics to health, and obvious and easy measures to employ for guarding against the risk of gout
Remember! When symptoms of gout in the ankle start to become apparent, it is critical to take fast action.
Treating A Gout Attack
Treating an attack of gout doesnt lower your urate levels or stop future attacks. The treatment helps you to manage your symptoms when an attack happens.
Themostcommon drugtreatments for attacks of gout are:
Some people will be better suited to NSAIDS, while for others NSAIDs cannot be used. But your preference is also taken into consideration.Many people with gout quickly learn what works best for them.
In cases where one drug doesnt seem to be working on its own, your doctor might suggest a combination of NSAIDs with either colchicine or steroids.
Non-steroidal anti-inflammatory drugs
Attacks of gout are often treatedwith NSAID tablets, which can help with pain andreduce some of your inflammation. Naproxen, diclofenac,and etoricoxibare three NSAIDs you could be given.
If youve been prescribed NSAIDs to treat an attack, you should start taking them as soon as you notice signs of one coming on.Your doctor may let you keep a supply soyou can start taking them at the first signsof an attack.
The earlier you start treatment, the better.
NSAIDs arent suitable for everyone, so talk to your doctor about them first if you have any other conditions. They can also interact with other drugs, so make sure you talk to a doctor before starting on any new medication.
Colchicine
Colchicineisnt apainkiller.Butcan be very effective at reducing theinflammation caused by urate crystals.
You should avoid taking colchicine if you have chronic kidney disease.
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Treatments To Prevent Gout Attacks
There are drugs available that can lower urate levels, prevent new crystals from forming and dissolve away the crystals in your joints. They are called urate lowering therapies .
Treatment with ULTs is generally started after an attack of gout has completely gone.
Theres no single fixed dose of a ULT, and different people need different doses to get to the right blood urate level.
It can takea few months or yearsfor the drugs to completely clear your body of urate crystals. But once theyre gone,you will no longer have attacks of gout,tophior risk of joint damagedue to gout.
Its important torememberthatULTswont stop attacks of gout straight away.Youmighthavemore attacks within the first six months of startingthem.
Dont stop taking yourULTs if this happens to you, as this isactually asign that the drugs areworking. As the drugs start dissolving the crystals,they become smaller and are more likely to get into the joint cavity,triggeringan attack.
Your doctor might suggest taking a low dose of colchicine orNSAIDas a precautionagainst attacks during the first six months of starting ULTs.
ULTs are usually life-long treatments and require yearly check-ups to monitor your urate levels.If your symptoms arent getting under control,talk to your doctor about your urate level,as you might need to be on a higher dose.
Allopurinol
Allopurinol is themost commonly usedULT. Its a very effective treatment for most people with gout.
The Role Of Diet In Gout Prevention
Dietary control may be sufficient in a patient with mildly elevated uric acid, for example, 7.0 mg/dL
For those with a higher level, for example, 10.0 mg/dL, diet alone will not usually prevent gout. For the latter, even a very strict diet only reduces the blood uric acid by about 1 mg/dL- not enough, in general, to keep uric acid from precipitating in the joints. The cutoff where patients with gout seem to dramatically reduce their number of attacks is when their uric acid level is taken below 6.0 mg/dL.4
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What Can Trigger An Attack
Several thingscancause the crystals to shakelooseinto your joint cavity, triggeringan attack. These include:
- a knock or injury to the joint
- an illnessthat gives you a fever
- havingan operation
- having an unusually largemeal, especially a fatty meal
- drinking too much alcohol
- startingurate lowering therapy, especially at a high dose, or not taking your ULT regularly each day.
Surgical Treatment For Gout Includes:
When patients have repetitive gouty attacks in a joint, the joints can become destroyed. This can lead to severe pain and disability. In cases where the symptoms are not relieved by conservative case, Dr. Stewart generally recommends surgery to fuse the joints affected by gout. Once the joint is fused, gout will no longer occur as the joint space has been eliminated.
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Important Information About Gout Medication
If you are taking medication to lower uric acid, you need to take it every day, whether you are having an attack or not.
Treatment is important to reduce gout attacks and avoid permanent joint damage. However, as all medicines have side effects, discuss medication choices with your doctor by asking:
- what are the benefits of gout medication?
- what are the risks of this medication?
- what are the side effects?
Always let your doctor or pharmacist know what medicines you are taking to avoid interactions. It is also a good idea to discuss if you want to stop or change the dose of your medications.
Natural Remedies Of Ankle Gout
- Drink more water As gout causes inflammation and swelling in joints, you need to drink much amount of water. By drinking water, you can reduce the swelling condition. Intake of more fluid will encourage your kidneys to discharge fluids. That is why you can alleviate swelling at your joints.
- Add ginger to your diet Ginger has anti-inflammatory properties, and thus, you may use it for gout treatment. To make this home treatment effective, you have to boil water and add one tablespoon of grated ginger. Then, apply ginger to the affected part. You must do it at least once every day for about 15 to 30 minutes. You may also drink the solution of water and ginger daily.
- Cherries Researchers have noticed that the consumption of cherries can minimize the gout risk. Cherries have anthocyanins that fight against inflammation. So drink cherry juice regularly to reduce your gout symptoms.
- Apply ice Cover an ice pack in a cloth and apply it to your affected part. This trick will help you in reducing inflammation. Leave the ice pack for 10 to 20 minutes.
- Apple cider vinegar It is another solution for your pain and swelling issues caused by gout. Add a spoon of vinegar to warm water. You will slowly get relief in this condition.
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What Are Treatments For Gout In The Ankle
Since gout is a chronic disease, there is no cure. However, medications and self-management strategies can help manage gout. The treatment goals include:
- managing pain during a gout flare-up
- reduce the frequency and severity of flares
- preventing joint or organ damage by treating tophi in later stage gout
What Does Gout Feel Like
Gout feels different for everyone and may depend on the specific joint or area affected. The area may be stiff and extremely painful, even painful enough that having anything touching the area is unbearable. The pain can be on the joint only or in the area around the joint as well.
Tophi are bumps that can appear on the skin with gout. They are usually not painful. However, they can swell and become painful.
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What Causes Gout In The Ankle
Gout is a type of metabolic arthritis. Gout occurs due to elevated levels of uric acid in the blood. Uric acid is a waste product when the body metabolizes purines found in body tissues and some foods. Purines can be harmful in large amounts.
With gout, large amounts of uric acid accumulate in the joints, forming crystals. Not everyone with high levels of uric acid will get gout.
The body normally manages uric acid levels by excreting uric acid through the kidneys as urine. Certain health conditions, medications, and foods can increase your risk of getting gout:
- health conditions, such as chronic kidney disease, psoriasis, and cancer
- medications, including diuretics, low dose aspirin, and niacin
- certain foods and beverages that are high in purines
In later stages of gout, crystals can build up in the soft tissues, tendons, skin, or internal organs such as the kidneys. These are called tophi. Depending on where they form, tophi can cause permanent joint or organ damage. Proper gout treatment can prevent tophi from forming or dissolve it if it has already started forming.
With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis. Many people can decrease the severity of their symptoms and avoid gout flares.