Conditions / Systemic & Complex
Gout
Sudden, severe big toe joint pain that appears overnight is the hallmark of gout. We can help diagnose an acute flare, manage joint damage from recurrent gout, and advise on footwear and offloading to protect affected joints.
Gout is a form of inflammatory arthritis caused by the deposition of monosodium urate crystals in joints and surrounding tissues. It occurs when uric acid levels in the blood become elevated — a condition called hyperuricaemia — and crystals form in the cooler peripheral joints, most commonly the first metatarsophalangeal joint (base of the big toe).
Gout presents as sudden, intensely painful episodes — often waking patients from sleep — with redness, swelling and heat around the affected joint. Without management of uric acid levels, attacks become more frequent and can lead to chronic tophaceous gout, joint damage and deformity.
While gout is a systemic condition managed medically by a GP or rheumatologist, podiatrists play an important role in acute flare management, joint protection, footwear advice, and managing the long-term foot and joint consequences of recurrent gout.
Elevated Uric Acid
Hyperuricaemia — from overproduction or under-excretion of uric acid — allows crystals to form in joints. The underlying cause requires medical investigation and management.
Diet & Alcohol
High purine foods (red meat, shellfish, organ meats) and alcohol — particularly beer — raise uric acid levels and are common dietary triggers for acute flares.
Dehydration
Reduced fluid intake concentrates uric acid in the blood, increasing the risk of crystal deposition in joint spaces.
Medications
Diuretics, low-dose aspirin and some blood pressure medications can raise uric acid levels and precipitate gout attacks.
Genetics
A family history of gout significantly increases risk — many people have an inherited tendency to retain uric acid.
Comorbidities
Obesity, hypertension, diabetes and chronic kidney disease are all associated with elevated uric acid and increased gout risk.
Sudden, severe pain in the big toe joint — often waking you from sleep
Intense redness, warmth and swelling at the affected joint
Even light touch or the weight of a bedsheet causes pain
Flares typically resolve within 3–10 days without treatment
Recurring attacks over time if uric acid is not controlled
Tophi (chalky deposits) under the skin in chronic gout
Gout requires both medical management (uric acid-lowering medication from your GP) and podiatric management of the foot and joint consequences. We work alongside your GP and can refer for blood tests and specialist review where needed.
01
Stay well hydrated — aim for 2–3 litres of water daily to dilute uric acid
02
Reduce high-purine foods — red meat, shellfish, organ meats — and limit alcohol especially beer
03
During an acute flare, rest and elevate the affected foot and apply ice wrapped in a cloth
04
Take any prescribed urate-lowering medication consistently — stopping and starting can trigger flares
If you have sudden, severe joint pain with redness and swelling — particularly in the big toe — book an assessment. Gout is often misdiagnosed as infection or injury, and accurate diagnosis changes management significantly.
If you have a hot, red, swollen joint with fever, seek urgent medical attention — septic arthritis (joint infection) must be excluded as it is a medical emergency requiring different treatment.
Is gout only in the big toe?
The big toe joint is the most commonly affected site — a presentation called podagra. However gout can affect any joint including the ankle, knee, wrist and fingers. The foot and ankle are among the most common sites due to lower tissue temperature facilitating crystal formation.
Can diet alone control gout?
Dietary changes can reduce the frequency of attacks, but for most people with established gout, urate-lowering medication prescribed by a GP is also required to adequately control uric acid levels and prevent joint damage over the long term.
What is the difference between gout and a bunion?
Both can cause pain and swelling at the big toe joint, but they are entirely different conditions. Gout is a crystal arthropathy with sudden inflammatory flares. A bunion is a structural deformity of the joint. A clinical examination and, where needed, blood tests and imaging will distinguish between them.
Do I need a blood test?
A blood test measuring serum uric acid is helpful but not always diagnostic — uric acid can be normal during an acute attack. Clinical assessment combined with blood tests and joint fluid analysis (if available) gives the most complete picture. We can refer you for appropriate testing.
Ready to book your assessment?
We'll diagnose your condition, manage the joint, and work alongside your GP to reduce flares and protect your foot long-term.
