Gout in the Ankle

Gout is a metabolic disorder and type of painful arthritis that occurs as uric acid levels build up in the blood. It causes the formation of sharp crystals in joints around the body, leading to pain, swelling, and tenderness in the joints. Gout is often found in the big toe, but it can also occur in other joints, including the ankle.

When gout affects the ankle joint, movement becomes uncomfortable. Consequently, it can hinder carrying out the activities of daily living. While the condition has no cure, its symptoms can be managed, and flare-ups can be prevented.

Find out more about gout attacks, its symptoms, causes, risk factors, diagnosis, complications, and treatments.

Symptoms of Gout in the Ankle

Gout can be unpredictable. You can have gout with no symptoms for a long while and then suddenly experience pain and other symptoms, which can last a few weeks before abating. While no symptoms are experienced during times of remission, there will also be periods of flare-ups when symptoms occur.

The symptoms may sometimes be limited to a joint (often the big toe), but they can also occur in several joints in the body. As with most other types of arthritis, gout presents with the following symptoms:

• Pain
• Tenderness
• Swelling
• Redness
• Warmth to the touch
• Joint stiffness and limited range of motion

Causes and Triggers of Gout in the Ankle

Gout occurs when there is a concentration of uric acid in the joints. Uric acid is a byproduct of purine breakdown—a chemical found in certain foods and drinks.

Uric acid travels in the bloodstream and passes through the kidneys for excretion from the body. Sometimes, however, the urine cannot handle the volume of uric acid, either because there is an overproduction of uric acid or because the kidneys are not functioning efficiently.

Consequently, more uric acid begins to circulate in the body and accumulates in the joints. This leads to the formation of the painful acid crystals responsible for gout.

Who Is Predisposed to Gout in the Ankle?

Gout is a common form of arthritis, and several factors predispose people to develop it. The risk factors include:

• Gender Uric acid buildup is frequently worse in men than women. The only exception is post-menopausal women, who have higher uric acid levels.
• Genetics While there is still a lack of evidence, genetics seem to play a part in the production of uric acid.
• Diet Consuming foods rich in purines (e.g., alcohol, sweetened drinks, and red meats) can also increase your chances of developing gout.
• Medications Diuretics are another risk factor for developing gout.
• Hypertension High blood pressure is often linked to an increase in serum uric acid.
• Obesity Being overweight can sometimes reduce your kidney function and lead to an increase in inflammatory chemicals.

How Gout in the Ankle Is Diagnosed

As previously stated, gout can be unpredictable. Generally, gout is easier to diagnose in the middle of a flare-up than in remission. If you suspect you may have gout, you should see your doctor while you have symptoms. Remember, self-diagnosis involves many risks, so it's always best to receive an accurate diagnosis and the most suitable treatment plan from a medical professional.

Your doctor will ask you about your family history, diet, and medication. The responses will help your doctor arrive at an accurate diagnosis while ruling out other potential causes of ankle pain. The doctor can also distinguish gout from other conditions occurring in the same region of the foot. For example, gout in the big toe and sesamoiditis, bunions, and plantar fasciitis all occur in the forefoot region. Similarly, ankle arthritis must be distinguished from gout in the ankle.

Your doctor might request additional investigations. A blood test profile, for example, helps to measure uric acid levels. However, it is not prognostic, as many others with high uric acid levels don't experience gout. Instead, you can combine the X-ray, MRI, and CT-scan examinations to eliminate any other form of inflammation. An ultrasound may also be used to confirm if there are crystals in your ankle.

Furthermore, a joint fluid test can be used to take fluid from the ankle. Depending on how you fare in the exam, you may need to see an inflammatory arthritis specialist called a rheumatologist for treatment.

Complications Associated With Gout in the Ankle

When the flare-ups become more frequent, and the condition remains untreated, you are at an increased risk of developing complications. Gout can cause damage to the ankle joint over time. Some of the most common complications caused by the condition are:

• Tophi A deposit of uric acid crystals can harden under the skin and form clumps. These clumps are known as tophi. While they are not inherently painful, the tophi can worsen inflammation and cause swelling and tenderness.
• Joint damage and deformity Frequent swelling of the joints will cause the joint to become deformed, and this can cause damage to the joint.
• Kidney-related complications These include kidney disease, kidney stones, kidney failure, etc.
• Psychological and emotional distress When gout is experienced as chronic pain, it can cause emotional distress as normal activities become difficult or impossible to do.

Treatment Options for Gout in the Ankle

Gout has no cure. However, you can reduce the frequency and duration of each flare-up with the correct treatment. Treatment involves a combination of medication with several conservative therapies. Some of the treatments include:

• Medication Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, prescribed NSAIDs, corticosteroids, and colchicine (Colcrys), can help relieve pain, limit inflammation, and reduce flare-ups. Another medication, probenecid (Probalan), helps the body eliminate excess uric acid directly. Using them can help control the symptoms of gout. Conversely, diuretics and immunosuppressants should be used under supervision, as they can increase the risk of flare-ups.
• Diet Purine-rich meals like gravy, red meat, alcohol, and some kinds of seafood increase your risk of uric acid formation and should be avoided. Instead, you should consider upping your intake of fruits, vegetables, and whole grains.
• Weight loss Draft a plan to help you lose weight if you’re obese or overweight. Exercise, diet, and lifestyle changes will help you lose weight and reduce your risk of developing gout. Doing something as simple as walking can ease your symptoms and help you lose weight.

Bottom Line

Gout is painful and debilitating when it occurs. It will usually start in the big toe but can progress to other joints, making movement difficult. Fortunately, gout is treatable with medication and lifestyle changes. The goal should be to diagnose it as soon as possible so that intervention can begin and complications can be prevented.