The Center for Podiatric Care and Sports Medicine

Gout: Painful & Often Misdiagnosed

Posted by on Friday, July 3rd, 2015

The NYC podiatrists at The Center for Podiatric Care and Sports Medicine treat every condition affecting the foot and ankle one could think of, but few are as unendurable as an acute gout attack. Gout is a type of arthritis and a chronic disease that can cause serious damage if it’s not diagnosed and treated as such. Uric acid crystals can form in other organs outside of the toe joint, causing a range of serious health issues. Gout complications include: joint destruction and deformity; kidney stones and kidney disease; heart disease; dry eyes and cataracts; and diminished lung capacity. Our gout treatment is comprehensive — involving not only short-term and long-term pharmacological treatment, but also dietary and lifestyle recommendations. Yet, all this is only possible with an effective diagnosis obtained from your local NY podiatrist.

gout attacks
Long-term treatment with urate-lowering therapies is often necessary to prevent future gout attacks. Image Source: NicolePajorMoore.com

What does gout feel like?

Kathleen Sundbye said it felt like “a burning, pins-and-needles sensation in the little toe of her right foot that lasted for two weeks.” The 63-year-old retired social worker told the New Jersey Star-Ledger“The pain was unbearable and seemed to come from the inside out, so I thought that maybe I had a piece of glass lodged in my toe.” Finally, she went to the emergency room at 2 a.m. with excruciating pain. “I literally wanted to cut my foot off,” she recalled.

How is gout diagnosed?

Typically, we diagnose gout by reviewing a patient’s history and performing a few lab tests. Age (particularly over 65), sex (predominantly male, but also post-menopausal female), weight (higher BMIs), diet (lots of red organ meat, seafood, beer, high fructose corn syrup), and family history are all risk factors for gout. Many gout patients also have kidney and cardiovascular issues and take medications for other conditions like hypertension, diabetes or hormone deficiencies.

The best time to diagnose gout is during an attack, when we can remove joint fluid and examine it for crystal formation under a microscope. The process is not any more painful than having blood drawn, it only takes less than a minute to do, and we use a numbing spray to diminish the discomfort as well. Looking at joint fluid can also rule out other causes of inflammation — like infection or other types of crystals observed in another type of arthritis called pseudogout. Uric acid levels can also be checked in a urine sample.

Why is gout misdiagnosed?

There are several reasons why gout is often misdiagnosed:

– Blood tests aren’t reliable. Levels of uric acid are elevated at some point during the disease, but it can appear normal — even during an attack because all the uric acid often gathers in the joints and not in the blood serum. People with chronic gout often have hyperuricemia in the absence of acute inflammation, in fact.

– Gout causes other issues that obscure the root cause. Many gout patients are treated for kidney stones instead, which can be triggered by gout, especially if gout has been present in a person’s system for years.

– Symptoms are very similar to other conditions and seem to come and go randomly. Doctors have misdiagnosed gout as neuropathy, bursitis, infection, or another type of arthritis.

– Women are not viewed as likely candidates. While gout occurs 3-4 times more frequently in men, it should not be automatically ruled out as a possibility for women. The prevalence in women has doubled in the last 30 years, from 5% to up to 25% of all cases among people in their 70s. Men often see gout in their ankles and feet, while women tend to exhibit symptoms in their toes.

– Gout carries a stereotype as a disease of the “old and fat.” In reality, we treat elite athletes and very thin individuals for gout, too. There’s a genetic component to gout that can make some people more susceptible than others.

Wondering where to find NYC Gout treatment?

Your first instinct may be to visit your general practitioner, but The Center for Podiatric Care and Sports Medicine in NYC is a better bet. We are fully equipped to run the necessary blood test necessary to diagnose gout. Our sympathetic and knowledgeable board-certified podiatric surgeons and podiatrists have experience in treating this painful condition. We’ll not only write you a script for a medication that will effectively take your pain and swelling away, but we’ll also counsel you on diet triggers, natural remedies for gout, and prevention strategies to avoid future attacks. Contact us to be seen without delay.

If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.