Symptoms
That sudden, burning pain in your big toe may be more than an ache. Here’s what gout is really telling you – and why you shouldn’t ignore it.
Inflammatory arthritis
It can happen overnight. One minute you’re fine; the next, the joint at the base of your big toe is throbbing, swollen and so sensitive that even the touch of a bedsheet is unbearable.
The skin may look red and feel hot. The pain can be sharp, burning, or intensely tender. And while it might seem like you’ve somehow injured your toe without realising it, there could be another explanation: gout.
“Gout is an inflammatory form of arthritis caused by the build-up of uric acid crystals in a joint,” explains Dr Gordon Robertson, a specialist physician at Mediclinic Durbanville.“ The resulting inflammation can cause a very sudden and severe attack of pain.”
What causes the burning pain?
Uric acid is a natural waste product that forms when your body breaks down substances called purines, which are components of DNA. Normally, the kidneys filter uric acid from your blood, and it leaves the body through your urine.
“But if your body produces too much uric acid, or your kidneys don’t remove enough, levels can build up in the bloodstream,” says Dr Robertson. “In most cases of gout – more than 8 in 10 – it’s caused by your kidneys under-secreting uric acid, which is mostly genetically determined.
“Eventually, high levels of uric acid can precipitate and form tiny, needle-like crystals in and around a joint. Your immune system reacts to these crystals, triggering inflammation – and that’s what causes the characteristic pain, swelling, redness, and heat of a gout attack.”
The joint at the base of your big toe is particularly prone to gout, although attacks can also affect your ankles, knees, fingers, wrists, and elbows.
Why does gout often strike at night?
For many people, a gout attack seems to come out of nowhere, often during the night or early morning.
There are several possible reasons. “Body temperature tends to drop slightly during sleep, which may encourage uric acid crystals to form in a lower-temperature environment. This is often why it affects the feet and extremities,” says Dr Robertson. “Dehydration overnight can also contribute to higher concentrations of uric acid. Joints that are already damaged, for example, by osteoarthritis or previous trauma, are also affected.”
Whatever the trigger, the result can be an attack that develops rapidly and becomes extremely painful within hours.
Is gout caused by eating rich food?
Not necessarily.
“Gout has long been associated with rich food and alcohol but blaming it entirely on diet oversimplifies the condition. Diet only contributes to 30% of your blood uric acid; the rest is produced as natural byproducts of normal metabolism. Patients are often unfairly blamed for not adhering to a ‘gout-friendly’ diet, but gout mostly occurs when your kidneys don’t eliminate uric acid properly, which is genetic,” says Dr Robertson. “Of course, diet does have a role but it’s probably less important than traditionally assumed. Gout usually occurs apart from dietary extremes, such as heavy alcohol consumption or very high intake of purine-rich meats and shellfish.”
Some foods – including organ meats, some red meats, and seafood – are high in purines, while alcohol and sugary drinks can also contribute to increased uric acid levels.
“However, genetics, kidney function, excess body weight and certain health conditions can all influence your risk. Some medications, including certain diuretics, may also increase uric acid levels.”
In other words, gout isn't simply a lifestyle failure.
What should you do during an attack?
If this is your first episode of sudden, severe pain and swelling in your big toe, always consult a healthcare professional. Several conditions can cause a painful, swollen joint. For example, a bacterial joint infection can be serious and requires urgent medical attention.
“Treatment focuses on relieving pain and inflammation during an attack, often with medicines such as anti-inflammatory drugs and rest,” says Dr Robertson. “For people with recurrent attacks (two or more per year) or bumps visible on their skin and joints (called ‘tophi’), we use long-term medication to lower uric acid levels to normal and prevent future attacks and joint damage.
“Gout is a completely treatable illness and if treated early, a person can avoid long-term irreversible damage to their joints. Even uric deposits in their joints (tophi) can potentially be reversed over time with the right treatment.”
Resting and elevating the affected foot, applying a wrapped ice pack, and staying hydrated may also help with symptoms.
Don't just treat the pain – treat the cause
If you have recurrent gout, your doctor might prescribe medication to lower uric acid levels and reduce the risk of future attacks.
They may also recommend lifestyle changes like maintaining a healthy weight, drinking enough water, exercising regularly, and moderating your intake of alcohol and certain high-purine foods.
The sooner you understand what's causing the pain, the sooner you can treat the attack, manage your uric acid levels, and reduce the chances of that fiery pain returning.