Preparing for the “Elder Boom”

For those of us (and I mean us because I am one) who suffer from

If you awaken in the middle of the night to find a swollen, pulsating and painful big toe, you may well be having a gout attack. (Photo courtesy of www.myfootshop.com)

chronic pain and swelling in our big toes, sometimes to the point where even the blowing wind causes substantial discomfort, we can relate to those of you who suffer equal pain and despair and don’t know what’s wrong with you.

If you’ve ever had a big toe so swollen and purple that it hurts just to look at it, or a knee that balloons up every now and then, you know what Hippocrates was describing when he wrote about the “disease of Kings.”

It’s called gout.

Gout, my friends is an ancient, complex, frequently uncontrolled, metabolic disorder that involves the presence of abnormally high levels of a substance called uric acid in the circulation. The two-dollar word for it is hyperuricemia. Gout, or hyperuricemia, can be caused by several factors, and diet is a major contributor. Genetics can also play a role.

According to the National Health and Nutrition Examination III conducted from 1988-1994, more than five million people suffer from gout in this country. The numbers since then have continued to increase. It affects men three times more frequently than women and African-American men 45 years of age or older suffer from gout more than their Caucasian counterparts in the same age group.

Two main types of gout exist. One type produces large bumps or nodules that are filled with uric acid, or tophi. The other does not. These nodules are frequently seen in the lower eyelids, external ears and finger joints.

The main culprit here is the uric acid, which is essentially a waste product that is formed during the breakdown of many foods we eat, mainly proteins, during the process of digestion. Under normal circumstances, uric acid is deposited into the blood stream where it is carried to the kidneys and excreted in the urine.

Occasionally, the level of uric acid in the blood becomes high enough that crystals comprised of uric acid cannot be adequately filtered out through the kidneys and can settle out of the blood and into such vulnerable locations as the linings of joints, primarily the big tow. The presence of these irritating crystals causes inflammation of the joint lining, called synovitis. This, in turn, leads to pain, swelling, discoloration and more pain.

How is gout diagnosed?

Typically, it is diagnosed from patient history and blood tests that measure uric acid levels in the blood. People have described their “attacks” as so painful even the weight of bed sheets on the foot/toes is intolerable. They report swollen big toes, discolored to the point of a bluish hue, and an admitted dietary pattern of rich foods, high red meat and alcohol consumption.
How do you treat gout?

Gout can be treated, usually successfully with diet modification that reduces excess red meat and alcohol consumption, together with the addition of a uric acid lowering drug. This combination usually works well, but doesn’t guarantee a life without an occasional flare up. Often times, your family doctor will refer you to a rheumatologist, a physician who specializes in arthritis-type diseases and conditions, for medical management.

Gouty attacks

A gouty attack, or flare up, is caused when uric acid crystals become deposited in a joint. Joints of the lower extremities are the typical recipients, but these attacks can literally happen anywhere. The synovial lining of joints becomes extremely inflamed in the presence of these crystals, thus intensifying the pain and swelling.

There are two main treatments for these flare ups; non-steroidal anti-inflammatory drugs (NSAIDs) and cortisone injections into the affected joint(s). It can sometimes take several days for a flare up to subside to the point of being able to wear shoes.

So, if you awaken in the middle of the night to a large, pulsating, painful big toe that “shines like a beacon in the night,” you may well be having a gout attack. Call your doctor so you can get it checked out. 

Chisholm’s expertise in nursing, orthopedics and surgery spans more than 30 years. He holds multiple national certifications in these specialties. His goal is to empowering people through education and information to become more engaged, proactive and responsible in their orthopedic health, and health care. For additional information on orthopedic-related topics, visit Ken’s Web site at www.bone-and-joint-pain.com. Submit questions or comments to Ken at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or at his Web site.

If you awaken in the middle of the night to find a swollen, pulsating and painful big toe, you may well be having a gout attack. (Photo courtesy of www.myfootshop.com)