By Joe Altepeter, DPM
Living here in Fort Myers, we are blessed with a climate that encourages us to stay on the move. Whether you are spending your Saturday at the downtown farmers market, hitting the links at your favorite golf course, or enjoying a sunset walk at Fort Myers Beach, your mobility is your greatest asset. However, nothing brings that active Southwest Florida lifestyle to a grinding halt, like the sudden, agonizing onset of a gout flare-up.
As a podiatrist at Family Foot & Leg Center, I often see patients who come into our office convinced they’ve broken a bone or developed a severe infection overnight. While “gout” is frequently used as a misnomer for any general pain or swelling in the feet , it is a specific medical condition related to the buildup of uric acid. While it isn’t the only cause of foot and ankle pain, those who have suffered through an attack can attest that it is one of the most significant and debilitating issues we treat.
The Science of the “Foot-Trap”
Gout occurs when uric acid, a natural byproduct produced as the body breaks down purine compounds, begins to accumulate. Normally, the kidneys eliminate this byproduct through urine. The problem arises when there is a breakdown in this process—either the body cannot further break down the acid, or it fails to transport the particles to their final destination. This retention allows uric acid to build up and crystallize within the joints, making them prone to an intense attack.
While gout can occur in various nearby joints, it is most commonly found in the big toe. This specific presentation is known as podagra, which appropriately translates to “foot-trap” in Greek. This joint is the largest in the forefoot and sits furthest from the heart, making it susceptible to temperature fluctuations and exposure to the environment. Because uric acid is highly sensitive to these changes, it crystallizes much more easily at cooler temperatures, where it begins wreaking havoc.
Identifying Your Triggers
Gout does not discriminate; it affects men and women of all ages, though we see it most frequently in men between the ages of 40 and 60.
Genetics play a massive role, as genes influencing how we produce and excrete uric acid are passed down through generations.
However, lifestyle and environment are major factors. One of our primary treatment strategies is preventative, involving dietary modifications to reduce purine intake. Common triggers include:
• Seafood and Shellfish: A local staple that is unfortunately high in purines.
• Meats: Red meat and organ meats.
• Beverages: Alcohol, including beer and red wine, as well as high fructose corn syrup.
• Vegetables: Deep green leafy vegetables and beans.
Beyond diet, other risk factors include high blood pressure, diabetes, and obesity. Furthermore, attacks can be triggered by high-stress situations such as surgery, chemotherapy, or other social stressors.
Recognizing the Classic Presentation
The presentation of gout in the foot is usually unmistakable. The affected joint typically becomes quite swollen, exhibiting deep redness and warmth that is far more significant than other arthritic processes. The pain is intense, with many patients complaining that even the light touch of a bed sheet is a significant trigger.
While these attacks can sometimes be self-limiting, they can take weeks or even months to resolve on their own. If a joint is subjected to recurrent attacks or prolonged uric acid deposition, it can lead to erosive changes and visible deformity. In severe cases, these deposits—known as tophi—can build up so significantly that the joint becomes swollen enough to rupture through the skin, causing ulceration and the expression of white, chalky debris.
Taking Control of Your Foot Health
The good news is that you don’t have to live in the “foot-trap.” It is vital to manage gout appropriately to avoid long-term damage. When you visit us at Family Foot & Leg Center, our initial workup includes plain film radiographs and blood work to confirm the diagnosis.
Once we determine you are suffering from gout, treatment can be initiated right away. Your personal plan may include:
• Medications: Corticosteroids and non-steroidal anti-inflammatories to manage inflammation.
• Injections: To help control localized pain and swelling.
• Lifestyle Management: Fluid management and specific diet modifications.
• Systemic Control: Medications to assist in the reduction of uric acid circulating in the body.
Don’t Let Gout Keep You Sidelined
If you are experiencing sudden redness, warmth, or debilitating pain in your big toe or ankle, don’t wait for it to “go away on its own.” At Family Foot & Leg Center, we are dedicated to providing Lee County with the highest level of podiatric care to keep you active and pain-free.
Disclaimer: This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition.
Joe Altepeter, DPM, AACFAS, is a Podiatrist at Family Foot & Leg Centers in Fort Myers FL. He is a Fellow of the American College of Foot & Ankle Surgeons. Call 239-430-3668 or visit www.NaplesPodiatrist.com to make an appointment. Visit FootHealthFacts.org to learn more about foot and ankle conditions.
1645 Colonial Blvd.
Fort Myers, FL 33907
(239) 430 – 3668 (FOOT)
www.NaplesPodiatrist.com