If you are a runner or triathlete and start to have pain in your big toe joint, you might be worried that it is gout. If so, it is important to get the right diagnosis.
Stages of inflammation from gout in the big toe joint.
Endurance athletes could be at risk of developing down simply because they push themselves to extreme limits. Dehydration has the potential to increase your risk of getting gout. Particularly if you have any problems with your kidneys. There are only so many different treatments for Gallup and none of them are really pleasant. So if you think you might have gout you should make sure you get the right diagnosis to start with.
Gout in the big toe joint or anywhere else in the foot is actually caused by uric acid crystals forming within the soft tissue. This typically happens in areas of the feet such as the big toe joint where the temperature is lower. The reason for this is that the high level of uric acid in your bloodstream can get to such a level that when the temperature decreases just a little bit it crosses the threshold for the crystals to start to form into needle shaped crystals to become deposited wherever they develop. Most common location for this is in the big toe joint.
Gout crystals cause extreme tenderness, redness and swelling in the big toe joint. There are lots of ways to try to diagnose gout but some are better than others.
There are really 5 ways to diagnose gout in the foot
1. Physical exam by a doctor
2. Foot X-rays
3. Blood tests
4. Joint fluid analysis
5. Cytology
Most of the time when a sports medicine doctor looks at your foot and you have a red swollen painful big toe joint, he will simply try to determine whether or not you have any of the more concerning problems they can resemble gout. Other common problems include turf toe, and infection in the big toe joint, or a fracture involving the big toe joint.
Basically if your foot is red and swollen and you have no history of trauma the doctor will be strongly considering a diagnosis of gout. If you have no reason that you would have developed an infection the Dr. becomes more suspicious that you have gout. If you also happen to have a family history of gout, you have recently participated in a marathon or triathlon where you could have become dehydrated and out is even more probable. This is particularly true if you have eaten a great deal of meat or red wine following your marathon or triathlon.
The reality is is that this is fairly reliable but not 100%. If your doctor is suspicious of a fracture or other traumatic injury to your foot you’ll probably want to get x-rays of the big toe joint. If this is your 1st attack of gout it is unlikely that the x-rays will show anything at all. Doubt only shows up after you’ve had crystals in your joints so long that it starts to wear away the bone where the joint capsule actually attaches to the bone. This is a specific finding called “Martels Sign.” most people have no evidence of this the 1st time you have an attack of gout in the big toe joint. So x-rays are not very reliable in the diagnosis of gout.
Blood tests try to determine whether or not you have a high level of uric acid in your bloodstream. When someone has a level of uric acid in their bloodstream (serum uric acid) of more than 6.8, we think of them is having too much uric acid even though this is at the high-end of the normal range (which goes to about 8). But unfortunately when you take blood out of your arm and you had just had an attack of gout, the uric acid is no longer even floating around in your bloodstream. That’s because the uric acid is just moved from your bloodstream into the big toe joint in the form of crystals. So if your doctor performs a uric acid blood test and comes back normal that’s what we call a false negative. in the center doctor has only proved that your uric acid is not high, he has not proved that you DON’T have gout. It this point you may be given antibiotics or some other type of treatment for a different condition other than gout.
A much better way for your podiatrist to make the diagnosis of gout in the big toe joint is actually to make the big toe joint numb and then stick a needle into the joint to remove the joint fluid and see if it has any material that looks like gout crystals. This is called “joint fluid analysis” or “joint aspiration” or “arthrocentesis.” This is also useful because if there’s any bacteria in the joint and the problem is caused by an infection it will appear cloudy due to the presence of bacteria, at which point you know you have to have antibiotics. If you have doubt, there will be chunks of white material that looks like chalk or toothpaste with in the joint fluid. This is almost always gout uric acid crystals. But sometimes it could be pseudogout crystals which are made up of calcium pyrophosphate.
The only way to tell the difference is through “cytology.” This is where your doctor takes the fluid that is been removed from your big toe joint and send it off to the pathologist in order to let them look at it under a polarized light microscope. Pseudogout crystals appear rhomboid shaped and sort of resemble the outline of the state of Utah. Gout crystals made up of uric acid however are needle shaped and very distinct. Because of their needle shaped, they also happen to look painful. If the pathologist looks at your joint fluid and sees these needle shaped crystals, that we know for sure you have gout.
If that point you will have all the information you need to make decisions about whether or not you want to start taking medication to treat gout or if you think you need to adjust your diet and start following a gout diet that will prevent the accumulation of uric acid in your bloodstream and lead to future attacks of gout.
You can learn more by viewing a video about the best way to diagnose gout by clicking here.
If you have pain redness and swelling around your big toe joint and you think the you might have an attack of gout, you can call and talk to an expert if you have a quick question. Dr. Christopher Segler is an award-winning foot and ankle surgeon who practices sports medicine in San Francisco, Tiburon, Mill Valley, Oakland and Berkeley. He makes house calls where he can evaluate patients for gout, perform joint analysis and send the specimen for cytology. He also performs remote consultations worldwide via web conferencing programs such as Skype, so that people in other areas of the world can get immediate answers to questions about their foot pain. You can reach him directly at 415–308–0833.