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What is gout?

Gout is a form of inflammatory arthritis caused by the deposition of monosodium urate crystals in and around joints. The crystals form when blood levels of uric acid are persistently elevated — either because the body is producing too much, not excreting enough, or both. When the crystals trigger an immune response in a joint, the result is a gout flare: sudden, severe pain, redness, swelling, and warmth in the affected joint.

The first metatarsophalangeal joint — the big toe joint — is the most commonly affected location, with such consistency that the medical term for big-toe gout is "podagra." Other foot and ankle joints can be affected, as can knees, ankles, and other joints. Flares often start at night and can be intense enough that even bedsheets touching the toe are intolerable. Risk factors include high-purine diets (red meat, organ meats, shellfish, alcohol — especially beer), obesity, certain medications (diuretics), kidney disease, and family history.

At Northwest Extremity Specialists, we manage the foot and ankle side of gout — diagnosing flares accurately, treating the acute episode quickly, and partnering with your primary care provider or rheumatologist on the long-term uric-acid management that prevents future flares. The first acute flare we see is often the patient's first gout diagnosis, and the right initial workup matters because the symptoms can also be caused by infection or other inflammatory conditions that need very different treatment.

See it in motion

What it feels like

A gout flare has a very characteristic presentation:

• Sudden onset of intense joint pain, often starting in the middle of the night
• Most commonly affects the big toe joint, but can affect ankles, midfoot, or other joints
• Marked redness and warmth over the affected joint
• Significant swelling
• Extreme tenderness — even light touch (bedsheets, socks) is painful
• Limited range of motion of the affected joint
• Symptoms peak within 24 hours and gradually subside over 5–14 days
• In chronic gout: visible tophi (firm nodules) under the skin around joints

Why it develops

Gout is caused by elevated uric acid leading to crystal deposition. Contributors:

• Genetic predisposition — the most important risk factor
• Diet high in purines (red meat, organ meats, shellfish, sugary drinks)
• Alcohol use, particularly beer
• Obesity and metabolic syndrome
• Certain medications (thiazide diuretics, low-dose aspirin)
• Kidney disease reducing uric acid excretion
• Dehydration
• Certain medical conditions (psoriasis, certain cancers)

How we diagnose gout

A first gout flare needs careful evaluation because the symptoms — red, hot, swollen joint — can also be caused by infection (septic arthritis) which is a true emergency. Your provider will take a careful history (prior episodes, triggers, family history), examine the joint, and check for tophi or other signs of chronic gout. Aspirating fluid from the joint to look for urate crystals under polarized microscopy is the gold standard for diagnosis. Blood uric acid levels help, but a normal uric acid does not rule out an acute flare. On-site X-ray may be taken to evaluate joint damage in patients with recurrent gout.

Non-surgical care

Treatment has two parts: acute flare management and long-term uric acid control:

• For acute flares: high-dose NSAIDs (indomethacin, naproxen) — first-line if no contraindications
• Colchicine for acute flares, especially within 24 hours of onset
• Corticosteroids (oral or joint injection) for flares when NSAIDs are not appropriate
• Ice, rest, and elevation during the flare
• For long-term prevention: urate-lowering therapy (allopurinol, febuxostat) — usually coordinated with primary care
• Dietary changes to reduce purine intake
• Weight management, hydration, alcohol reduction
• Review and adjustment of contributing medications
• Treatment of associated metabolic conditions

Surgical care

Surgery is rarely needed for gout itself but can be required for complications — particularly large tophi causing skin breakdown or significant joint damage from years of recurrent untreated flares.

• Excision of large or ulcerating tophi
• Joint debridement for advanced gouty arthritis
• Joint fusion (arthrodesis) for severely damaged joints
• Joint replacement in selected cases

Recovery depends on the specific procedure. Tophus excision typically heals in 3–6 weeks with protected weight-bearing. Joint fusion or replacement requires longer recovery and structured PT.

When to see a specialist

• A sudden hot, red, swollen joint — particularly the big toe
• A first suspected gout flare (the diagnosis needs to be confirmed)
• Recurrent flares despite known gout — your long-term management may need adjustment
• Visible tophi under the skin around joints
• A red, swollen joint plus fever (this could be infection — go to urgent care or ER first)

Acute gout flares are seen by any of our board-certified podiatrists across our 8 clinics. Long-term uric acid management is typically coordinated with the patient's primary care provider or a rheumatologist; we focus on the foot and ankle aspects of care and on managing complications like tophi or joint damage.

Frequently asked questions

• Arthritis
  Long-term untreated gout causes chronic arthritis in affected joints
• Bunions
  Big-toe joint gout can be confused with bunion pain
• Tendonitis
  Soft-tissue inflammation that can mimic acute gout in some patients
• Diabetic Neuropathy
  Diabetic patients often have higher uric acid and altered gout presentation