Can't Stub Your Big Toe While Sleeping - Can You?

Gout is a form of arthritis that often shows up in the big toe first

/ Author:  / Reviewed by: Joseph V. Madia, MD

"It first began about three weeks ago when I woke up thinking I'd broken my big toe," writes a gentleman on an online support forum. "As I now realize, this is a text book gout entrance. By that Monday - the 7th day - the pain had increased enough for me to decide it was time to visit the doctor. By Monday afternoon, my foot had swollen up and it had become almost impossible to walk," he recalls.

Gout can go from a painful throbbing in one joint - often the big toe - to something far worse.

What is gout?

Gout is a complex disorder that's actually a form of arthritis. It usually appears in one joint at a time, and the big toe is often the first place gout strikes.

It shows itself with sudden severe pain that includes tenderness, swelling and red inflammation. At first, these bouts may last only a few days or a week. But gout usually returns, lasts longer each time and becomes more painful, even disabling. As the disease progresses, more than one joint may be affected.

How do I know if I have gout?

Gout comes and goes pretty much the same way:

  • The pain comes on suddenly and often starts at night
  • It usually affects the big toe, knee or ankle joints
  • People describe the pain as throbbing, crushing or excruciating
  • The affected joint feels warm, is usually red and very tender - to the point that even having a sheet or blanket over it hurts
  • You may run a fever
  • The pain and symptoms may go away in a few days, but return from time to time
  • After one attack, more than half of the people will have another bout
  • You may go months or even years between attacks
  • Returning attacks usually last longer than the first

What causes gout?

Gout is caused when your body has too much uric acid. Uric acid is created when the body breaks down chemicals called purines that are found in some foods and drinks, including liver, anchovies, mackerel, dried beans and peas, beer and wine.

Uric acid should be dissolved in the blood, move to the kidneys and be removed in the urine. Gout can be result if your body produces too much uric acid or doesn't remove enough if it.

This build-up of uric acid forms crystals around the joint or tissue surrounding it. These crystals are what cause the arthritis-like pain, inflammation and swelling.

Incidentally, a condition that's sometimes confused for gout, known as false gout or pseudogout, is caused by different type crystals. False gout doesn't usually affect the big toe, but often causes problems in larger joints - knees, wrists and ankles.

Who gets gout?

Once known as "the disease of kings," gout was thought to be something rich people suffered from as a result of consuming too much rich food and drink.

Today, gout is quite common, with about two million American sufferers. Statisics show that:

  • More men than women get gout
  • Men usually get it between ages 30-50
  • Women become more likely to develop gout after menopause - ages 50-70

What are my risks of having gout?

A young man writes on the forum, "I was recently diagnosed with gout after a series of attacks I put down to a hiking injury. Sadly I'm only 22 so I'd imagine borderline alcoholism and bad diet are the cause and I've managed to cut both down...however after a few days partying with friends, I get the familiar soreness that becomes stabbing pain in my big toe."

There are risk factors for the disease. You may be at risk of getting gout if you:

  • Drink too much alcohol - especially beer - (more than two drinks a day for men and one for women)
  • Are overweight or obese, weighing 30 pounds or more over your ideal weight
  • Have a family history of the disorder, which accounts for about 25 percent of gout sufferers

Medical conditions

Also, your chances of getting gout are increased if you have but are not managing or being treated for:

  • High blood pressure
  • Diabetes
  • High blood fat levels (cholesterol, triglycerides)
  • Kidney disease
  • Sickle cell anemia
  • Leukemia
  • Narrowing of the arteries

Anything that requires quiet bed rest - recovering from surgery, severe illness or injury - can also increase uric acid levels.

Medication side effects

Some medications can also lead to gout:

  • Thiazide diuretics which are used to treat high blood pressure by reducing salts and water in the body
  • Low-dose aspirin
  • Cyclosporine, which is used in transplant patients to prevent organ rejection
  • Chemotherapy medications

How is gout diagnosed?

You will want to visit with your doctor to find out if you have gout or if something else is causing the problems. It's fairly easy to diagnose gout. Tests include:

  • Analyzing the synovial fluid that surrounds the joints to look for uric acid
  • Looking for uric acid in the blood and urine
  • Taking x-rays of the joint, which may be normal
  • Performing a synovial biopsy

How is gout treated?

During the first attack, your doctor will usually suggest that you take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. These should be taken at the first sign of symptoms.

If the pain is particularly bad, your doctor may:

  • Prescribe stronger pain medications
  • Prescribe Colcrys (colchicine) to reduce pain, swelling and inflammation
  • Inject steroids into the inflamed joint to relieve pain

Pain should go away within 12-48 hours with these treatments.

For ongoing gout (several attacks a year) or more serious forms of gout (gouty arthritis or uric acid kidney stones), there are several prescription strength medications you doctor may prescribe:

Does gout get worse over time?

Yes. In some people, gout does progress and get worse, causing:

  • Chronic (ongoing) gouty arthritis
  • Eventual joint deformities and loss of motion in the joints
  • Joint pain and other symptoms most of the time
  • Kidney stones or deposits in the kidney that can lead to kidney failure
  • Lumps below the skin around the joints and elsewhere called tophi

What can I do to help avoid gout attacks?

The best thing you can do is take care of the things that can trigger gout attacks -

  • Avoid or limit alcohol intake
  • Eat less animal protein, especially anchovies, sardines, oils, herring, organ meat (liver, kidney, and sweetbreads)
  • Avoid or cut down on legumes (dried beans and peas)
  • Avoid fatty foods - gravies, salad dressings, ice cream and fried foods
  • Limit vegetables that may trigger gout - mushrooms, spinach, asparagus, cauliflower
  • Eat enough carbohydrates - whole grains, fruits and vegetables
  • Drink lots of water - 8-10 glasses a day
  • If necessary, lose weight - but do it slowly, as quick weight loss may cause uric acid kidney stones to form

Talk to you doctor

This disorder is so painful that you will probably be seeing your doctor for help.  While bouts of gout can't always be eliminated,  you can help yourself by eating right and avoiding too much alcohol.

And when gout does strike, treatments are available to relieve symptoms.

Review Date: 
May 17, 2011