Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

What Is Gout?

Gout is a form of inflammatory arthritis caused by the deposition of monosodium urate (MSU) crystals in joints and surrounding tissues. These crystals form when blood uric acid levels are chronically elevated — a condition called hyperuricemia. Uric acid is a breakdown product of purines, compounds found in many foods and produced naturally by the body. When uric acid exceeds its solubility threshold in body fluids, it crystallizes — particularly in the cooler peripheral joints of the feet and ankles.

At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, gout is one of the most common inflammatory joint conditions we evaluate and manage. Understanding the full picture of gout — from acute attacks to chronic disease management — is essential for protecting your foot and ankle joints long-term.

Why Gout Loves the Foot

The first metatarsophalangeal (MTP) joint — the base of the big toe — is the most commonly affected joint in gout, a condition specifically called podagra. The big toe joint’s predilection for gout relates to its peripheral location (lower temperature favoring crystal formation), the high mechanical stress placed on it during walking, and possibly local tissue factors that promote crystal nucleation. The ankle, midfoot, and heel are also commonly affected. In fact, for many patients, the foot or ankle is the initial site of their first gout attack.

Recognizing a Gout Attack

Acute gout attacks are among the most painful experiences a patient can describe. Classic features include:

• Sudden onset — often waking the patient from sleep in the early morning hours
• Severe joint pain, classically described as feeling like the joint is on fire or being crushed
• Rapid development of swelling, redness, and warmth over the affected joint
• Extreme sensitivity — even the weight of a bed sheet causes severe pain
• Peak intensity within 12–24 hours of onset
• Spontaneous resolution over 3–10 days if untreated

Between attacks, patients may be completely asymptomatic, which can lead them to underestimate the severity of the underlying metabolic problem. However, each attack leaves behind additional crystal deposits and cumulative joint damage.

Diagnosis of Gout

The gold standard for gout diagnosis is identification of MSU crystals in joint fluid aspirated during an acute attack under polarized light microscopy — the needle-shaped crystals exhibit strongly negative birefringence. In practice, diagnosis is often made clinically based on the characteristic presentation, elevated serum uric acid, and response to anti-inflammatory treatment. X-rays are often normal early in gout but may show characteristic punched-out bony erosions with overhanging edges in chronic tophaceous gout. Advanced imaging including dual-energy CT and ultrasound can detect crystal deposits non-invasively.

Triggers for Gout Attacks

Common triggers include: dietary purine loading (red meat, organ meats, shellfish, beer); dehydration; alcohol consumption (all types raise uric acid); diuretic medications; rapid changes in uric acid levels from starting urate-lowering therapy; illness or surgery; trauma to the joint; and contrast dye for imaging studies.

Treating Acute Gout Attacks

The goal of acute attack treatment is reducing inflammation as rapidly as possible. Options include:

• Colchicine — most effective when started within the first 24 hours of attack onset; low-dose colchicine (1.2mg then 0.6mg one hour later) provides excellent relief with fewer side effects than older high-dose regimens
• NSAIDs — indomethacin, naproxen, or other NSAIDs provide rapid anti-inflammatory relief; contraindicated in renal impairment and with blood thinners
• Corticosteroids — oral prednisone, intramuscular injection, or direct joint injection provides potent anti-inflammatory effect; useful when NSAIDs and colchicine are contraindicated
• Joint aspiration — removing fluid from a severely swollen joint both provides diagnostic confirmation and immediate pressure relief

Long-Term Urate-Lowering Therapy

Treating only acute attacks without addressing the underlying hyperuricemia leads to increasing attack frequency, cumulative joint destruction, and development of tophi (deposits of urate crystals in soft tissues). Urate-lowering therapy (ULT) is indicated for patients with recurrent attacks, tophi, chronic gouty arthropathy, or uric acid kidney stones. Allopurinol is the most commonly used ULT, inhibiting xanthine oxidase to reduce uric acid production. Febuxostat is an alternative. The goal is to maintain serum uric acid below 6.0 mg/dL (below 5.0 mg/dL for patients with tophi) to dissolve existing crystals over time.

Dietary Modification and Lifestyle

Dietary changes alone rarely normalize uric acid to target levels but reduce attack frequency and complement medication. Key modifications include limiting red meat, organ meats, shellfish, and beer; increasing low-fat dairy (which is uricosuric); adequate hydration; weight management; and limiting fructose-sweetened beverages. Vitamin C supplementation (500mg daily) has modest uricosuric effects.

Chronic Tophaceous Gout in the Foot

In patients with long-standing uncontrolled hyperuricemia, tophi — firm deposits of urate crystals surrounded by inflammatory tissue — develop in the skin and soft tissues of the feet, ankles, and Achilles tendon. Large tophi can cause joint destruction, skin ulceration, and secondary infection. Effective urate-lowering therapy gradually dissolves tophi over months to years. Surgical removal is occasionally necessary for tophi causing mechanical problems, nerve compression, or skin breakdown that does not heal.

Balance Foot & Ankle evaluates and manages gout affecting the foot and ankle in coordination with primary care and rheumatology providers. If you are experiencing recurrent foot or ankle pain with swelling and redness, contact our Howell or Bloomfield Township office for evaluation.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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Gout Treatment & Management in Michigan

Gout attacks in the foot and ankle can be debilitating. At Balance Foot & Ankle, our podiatrists provide rapid pain relief for acute gout flares and long-term management strategies to prevent recurrence.

Learn About Our Foot Pain Treatments | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Dalbeth N, et al. “Gout.” Lancet. 2016;388(10055):2039-2052. doi:10.1016/S0140-6736(16)00346-9
2. FitzGerald JD, et al. “2020 American College of Rheumatology guideline for management of gout.” Arthritis Care Res. 2020;72(6):744-760.
3. Roddy E, Doherty M. “Gout. Epidemiology of gout.” Arthritis Res Ther. 2010;12(6):223.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.