OUCH – What's that Pain in my Toe?

a man clenches his toe in pain
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Ouch! Have you ever woken up with an excruciating pain in your big toe – literally? If this has every happened to you, it may be a symptom of a condition known as gout. Gout is an extremely painful form of arthritis that often comes on so suddenly that it takes people off guard and may last for several days. Gout usually affects one joint at a time, including ankles, heels, wrists, knees, fingers and elbows, but big toes seem to be the joints most commonly in pain.

What are the symptoms of gout? Gout is a common and complex form of arthritis that affects as many as 8 million Americans. An attack of gout may often come on quite suddenly, even waking you up in the middle of the night with the feeling that “your big toe is on fire.” The episodes of pain are often severe, accompanied by redness and swelling and tenderness in the joints. The pain is usually most severe during the first 4-12 hours after onset but may persist for several day.

What causes gout? Gout happens when uric acid – a by-product of metabolism – builds up in the body. Everyone has certain levels of uric acid which occur naturally in the bloodstream, but some patients seem more prone to attacks of gout than others. Increased levels of uric acid may be caused by diet, as well as some medications and disease states (such as chronic kidney disease and some blood disorders). A diet rich in meat and shellfish, liver, dried beans and peas, and anchovies may cause increased tendency for gout. Consumption of high amounts of sugary drinks and alcohol, especially beer, also increases the risk.

Stages and symptoms of gout. Health care providers describe four stages of gout which vary in symptoms and treatment.

  • Asymptomatic hyperuricemia: largely asymptomatic except for elevated blood levels of uric acid.
  • Acute gout: occurs due to elevated levels of blood uric acid and the development of uric acid crystals in joints, causing intense pain and swelling. Episodes come on suddenly and may last 3-10 days. A patient may experience multiple attacks over months or years.
  • Interval gout: the period between acute episodes without symptoms.
  • Chronic tophaceous gout: may occur if gout is left untreated, developing up to 10 years after initial onset. Hard nodules (tophi) develop in your joints and the skin and soft tissue surrounding them and can cause permanent damage to your joints.

How is gout treated? The best treatment for any condition, including gout, is to try to take steps to prevent it. These include:

  • Drink plenty of fluids, and limit alcohol and beverages sweetened with high-fructose corn syrup.
  • Limit intake of meat, fish, and poultry, using low-fat dairy products as alternative protein sources.
  • Maintain a healthy body weight.
  • Stop smoking.
  • Know your family history. Research indicates some genetic predisposition and men are more likely than women to develop gout, especially before menopause.

If your healthcare provider determines that you do have gout, medications may be used to treat acute attacks and prevent or prolong the time between future attacks.

Although gout is relatively common, especially in elderly patients, it is not a good idea to let it go untreated if you begin to experience symptoms. If you feel sudden, intense pain in a joint or have a fever and a joint is hot and/or inflamed seek medical care. Integrity Urgent Care is here for you! Call or walk in to any of our convenient locations, open 8 am – 8 pm, every day.


Kinman T. What is gout? Healthline [online]. Reviewed 11 Jan 2018.] Accessed 6 Oct 2018]. https://www.healthline.com/health/gout

Mayo Clinic Staff. Gout. Mayo Clinic Patient Care & Health Information [online]. [Accessed 6 Oct 2018]. https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897

McDaniels A. Gout can cause extreme pain in the joints. The Baltimore Sun [online]. 30 Aug 2018 [Accessed 6 Oct 2018]. http://www.baltimoresun.com/bs-hs-expert-gout-20180827-story.html

US National Library of Medicine. Gout MedlinePlus [online]. Last updated 14 Aug 2018 [accessed 6 Oct 2018]. https://medlineplus.gov/gout.html

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