Treatment For Gout In The Foot

'The Big Toe And The Heel - Prime Targets For Gout'

Does your toe swell with gout? Is your heel a pain with gouty arthritis? We offer independent expert advice on specific treatments for gout in the foot. No vagueness, just specific advice for exactly how to treat a painful foot with gout.

This is part of our series looking at specific treatments for gout in detail. Not just listing ‘exercise’, but which exercises for each part of your body affected by gout? Where so many ‘big’ websites seek to offer generic advice that doesn’t help at all, we seek to get to the heart of the issue.

Why Are Your Feet So Vulnerable To Gout?

Your feet and, more precisely, your big toes are the most common area to be affected if you suffer with gout. Just why your feet are so vulnerable is unclear.

Some parties claim this is down to temperature – urate crystals forming faster in cooler temperatures and your toes being among the coolest areas because they are furthest from the heart.

However, the truth is more complicated than that – as Roddy concluded in an article for the Journal Of Foot And Ankle Research, the reasons for gout appearing in the toe first are…

“multi-factorial in origin and arises from the unique combination of the susceptibility of the joint to OA and local anatomical considerations of temperature, minor physical trauma and biomechanical stress” (OA being short for osteoarthritis)

In other words, there are a number of reasons why gout will often attack your toe first.

Man in great pain with gout in his foot

The same is also true however of your heel – it’s distance from your heart and it’s propensity (likelihood) to suffer trauma or stress make it another prime target.

How gout forms…

Just as a quick reminder, gout is formed when your body produces more uric acid (from food/ drink consumption etc) than it can get rid of via your kidneys. This condition (where uric acid builds up) is often referred to as hyperuricemia.

Having a high level of uric acid doesn’t necessarily mean that you’ll suffer with gout, because it’s only when urate crystals are formed from the uric acid that gout begins.

These urate crystals then travel around the body in your bloodstream until they attach themselves to a joint and start to cause painful swelling and inflammation.

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Potential Treatments For Gout In The Foot

There are two basic methods of combatting gout or ‘gouty arthritis’ as is it’s full term – you either stop the pain of a gout attack or you take steps to prevent a future attack happening.

These are typically broken down as follows…

Stopping Gout Pain –

  1. Painkillers
  2. Ice Treatment
  3. Supportive Equipment
  4. Rest
  5. Elevation
  6. Keep It Cool
  7. Specialist Orthotics

Preventing Future Gout –

  1. Exercise
  2. Dietary Change
  3. Massage

What I want to do now is look very specifically at what you need to do to apply each of the above and achieve better treatment for gout in the foot

Treatment For Gout In The Foot – Pain Relief

1) Painkillers

We covered off a lot of this in our article on ‘gout pain treatments’, except to add that where your feet are concerned, if you feel a gout attack just about to start, you may be better gently applying an anti-inflammatory topical cream if your toes/ heel are not too painful.

This will potentially get to the source much faster than swallowing a tablet.

Other than that, the effect of painkillers is fairly universal, so doesn’t warrant special coverage here.

2) Ice Treatment

Where your foot is concerned, ice treatment is a great option for slowing down the blood flow and reducing the swelling/ bruising that will cause much of your pain. This is also easy to apply – any standard water-based foot massager can be filled with cold water and you just pop your foot in to soak.

Ideally you should add ice to the water, although never put ice directly on your skin as it could cause burns.

Alternatively, pop a towel in the freezer (in a plastic bag) and leave it for an hour, then get it out and gently wrap it around your affected foot. A bag of frozen vegetables is another option but can squash your foot, leading to a ‘trauma;’ and extra pain.

This is perhaps the 2nd best treatment for gout in the foot as it is easy to do, required little extra equipment and can potentially be carried out at work in an office if you are really suffering.

3) Supportive Equipment

In the case of treatment for gout in the foot, you really want to keep all your weight off your heel/ toes. This is not easy but by getting hold of a good pair of crutches , this can be achieved.

When it comes to gout in the foot, you are better off using crutches rather than a walking stick (that is often recommended), because they will take a lot more pressure off.

This is especially true if you get gout in both feet a walking stick will typically only take pressure off one side.

Choosing footwear…

The other really important element to consider around treatment for gout in the foot, is what footwear to choose.

When at home, you are best wearing open-toed sandals or bare feet. Both will keep your feet cool.

If open-toed sandals are not an option during the day, then make sure you wear shoes with laces – these are much easy to open wide and remove than other tighter shoe designs that really on being ‘slipped’ on.

I have seen examples of people who’ve cut the backs off their shoes altogether, but normally this doesn’t achieve a lot, since somewhere that will accept that as an option, will normally accept sandals anyway. And shoe amending does nothing for your toes either.

Don’t wear high heels…

One further point – if you suffer with gout at all, it is a very good idea to avoid high heels at all costs. The majority of Gout sufferers are statistically men, so this is perhaps a little less relevant.

But for all of you (woman or men) that choose to wear high heels – just don’t if you suffer with gout. The angle of your foot whilst wearing long heels, will actively promote urate crystals to from around your toes.

Furthermore, the angle will also cause regular trauma to your toes and heel. Even during recovery periods this is not a good idea as it will almost certainly hasten the time to your next gout attack and increase it’s severity.

High heels and gout just don’t mix!

High Heels - A Definite No No for Gout Sufferers

4) Rest.

In order to get good rest you need to make sure that you keep your feet cool and do not brush them on anything.

This is particularly true at bedtime, where one mistake can lead to hours of discomfort.

The key here for your feet is forward planning. Pin your bedsheets back so that your feet will poke out at night and not get touched by the duvet or covers. Basic clothes pegs can be used to clip one side of the duvet back, without freezing your partner.

Similarly, take a fan to bed at night and put it on a small chair by the side of the bed, angled to blast at your feet.

The cooler you can keep your feet, the more the swelling will go down and the likely you are to sleep most of the night.

5. Elevation

Ideally, you want your feet to be elevated above your chest level, to allow fluids to redistribute among the rest of your body. This can be very difficult in an office or at work generally, so is often reserved for when you get home.

Recline your armchair first or use a foot stool. Then place as many cushions under your knees/ calf muscles.

Remember – try not to touch your feet at any time, whether it be your heel or your toes that are causing you most pain.

6) Keep It Cool

Again, it is essential to keep any gout affected joint as cool as possible. In the case of your feet, this is always best done with the use of fans. Even small hand-held fans can provide vital comfort and can even be taken in to work.

If you don’t share an office, there is nothing stopping you from carefully removing your shoes and putting a small fan of your feet. Try not to tap your feet if you with gout – the minor trauma of all that tapping is bound to make it worse.

Another cool tip you can use even if you do have to wear smart shoes for work, is to cut the toes off a couple of your socks. It’s not a perfect solution (that would be bare feet kept about chest level), but is a compromise that can provide a little relief alongside the other measures covered.

7) Specialist Orthotics

A picture of 3 custom made insoles for pain relief

Specialist orthotics are custom-made insoles for your shoes that are designed to redistribute your weight on your feet. 

They help provide better treatment for gout in the foot by keeping weight off painful areas such as toes or the heel. Sometimes, they can even be used for prevention if the way you walk and balance is partly to blame for where your attacks. 

Analytic Equipment…

Walking over a ‘gaitscan’ machine (other names may be used, but effectively it’s a small treadmill) will measure your weight distribution and create a digitally designed insole. 

This insole can then either be used to prevent future foot trauma or indeed for pain prevention by moving force away from your affected digits. 

An image of a man walking across a gaitscan machine, measuring them for specialist insoles

Treatment for gout in the foot – prevention.

Exercise

This is one point that I think most ‘bland advice sites’ written by authors who pay a clinician to ‘approve’ it get horribly wrong. Exercise is always listed as a ‘cure-all’ without any recognition that certain exercises are better than others for different areas.

In the case of gout, you need to avoid trauma. Now trauma doesn’t mean injury – just constant impact causes tiny trauma that can attract gout. If you often suffer gout in your feet, then the last thing you want to do is go out running during your recovery.

Running is great for certain diseases/ activites, but not gout. Cycling is better if you enjoy cardio-based workouts, but swimming is best of all.

Reducing pressure…

The lack of pressure/ weight on your feet, makes swimming a perfect treatment for gout in the foot.

Rowing also is not advisable due to the pressure on your feet. Likewise, push-ups cause real pressure on your toes – unless you touch the floor with your knees rather than your toes (performing effectively a half-push up).

Sit-ups however, are really good again, especially with your feet in the air. Just don’t use a sit up bar or have someone holding your feet down. A standard abdominal crunch with your feet in the air however is a great exercise for feet that might suffer with gout.

Weight training is a bit of a mixed bag – dead lifting may cause gout in your feet because your feet are taking the pressure, while a lot of new shoulder/ arm lifting machines involve sitting and so taking the pressure off your feet are fine.

The best answer really is think hard about your exercise program – if it is likely to put extra weight/ impact on your feet and you suffer with gout in your feet, then try to steer clear.

Dietary Change

In truth there are no specific changes in your diet that relate directly to gout in your feet.

However, foods that have anti-inflammatory qualities (such as cherry juice) will have a greater impact on your feet than those that just reduce uric acid consumption (cutting back purine-rich foods).

Massage

This could have fallen to some extent in to both painkiller and preventative medicine.

Massage can both help to improve circulation and move the crystals, while also being a great healing tool to move forward and help prevent future attacks.

If you’re in the middle of a gout attack however, the last thing you want is someone handling your painful digits – this is where the water massager can come in as vital.

Soothing a painful heel or foot without putting any pressure on it.

Image of a foot massage for gout

To help further try starting with warm water to relax your tense muscles, but then consider replacing it with cold, icy water at the end (for the inflammation) and then elevating your foot. This will provide a triple-hit against the pain.

For prevention of future attacks however, a normal foot massage (which can be learnt by a partner) is a prefect remedy after a long day. Ease the muscles and help to repair any foot trauma from the day.

Even simply applying light pinching and rubbing pressure from your heel to the ball of your foot will help – it certainly doesn’t have to be professional, but should feel professional.

The Final Word –

Treatment for gout in the foot relies on both methods to ease the pain during an attack and then an effective strategy for preventing it’s recurrence in the future.

It’s really important however, to understand that if you most commonly get gout in your foot, then there are very specific actions that need to be taken to prevent it.

Hopefully this article has been of some help – if you have any further suggestions I’d love to hear them below.

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Further Gout-Related Reports...

References –

1. Edward Roddy (May 2011). Revisiting The Pathogenesis Of Podagra: Why Does Gout Target The Foot? Journal Of Foot And Ankle Research.

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