Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Gout — monosodium urate (MSU) crystal deposition disease causing acute inflammatory arthritis — preferentially affects the first metatarsophalangeal (MTP) joint of the foot (podagra) in 50–70% of first attacks, making it the most common cause of acute inflammatory monoarthritis of the first MTP joint and one of the most dramatic presentations in podiatric practice. The first MTP joint’s predilection for gout results from its peripheral location (lower temperature favors urate crystallization), trauma from ambulation, and relatively poor perfusion — a combination that allows uric acid to precipitate and deposit within the joint at concentrations that remain in solution at core body temperature.
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Clinical Presentation and Diagnosis
Acute gout attack: sudden onset of severe pain (often waking the patient from sleep), exquisite tenderness, warmth, erythema, and swelling — classically at the first MTP joint but can affect any joint; attacks are self-limiting (resolving in 7–14 days untreated) but recur with increasing frequency if uric acid levels remain elevated. Differential diagnosis: septic arthritis (must be excluded — joint aspiration and culture differentiates), cellulitis (gout erythema may be extensive), stress fracture, pseudogout (calcium pyrophosphate crystal disease — midfoot and ankle predilection; chondrocalcinosis on X-ray). Diagnosis: joint aspiration showing negatively birefringent needle-shaped MSU crystals under polarized light microscopy — the gold standard; serum uric acid (may be normal during acute attack); X-ray showing punched-out erosions with overhanging cortical edges (Martel sign) in chronic tophaceous gout. Ultrasound: the ‘double contour sign’ (urate crystal deposition on articular cartilage surface) is 76% sensitive and 84% specific for gout.
Acute and Preventive Treatment
Acute attack: NSAIDs (indomethacin 50mg TID × 5–7 days or naproxen — first-line); colchicine 1.2mg loading dose followed by 0.6mg 1 hour later, then 0.6mg BID (most effective if started within 24 hours); corticosteroid (prednisone 40mg × 5 days or intra-articular injection) for patients who cannot tolerate NSAIDs or colchicine. Urate-lowering therapy (ULT): indicated after 2 confirmed gout attacks, tophus, uric acid nephropathy, or nephrolithiasis; target serum uric acid <6 mg/dL (below the saturation point for urate crystallization); allopurinol (XO inhibitor — first-line, titrate from 100mg to 300–800mg based on response and renal function) or febuxostat (uricosuric). Dr. Biernacki at Balance Foot & Ankle evaluates and treats acute gout and pseudogout of the foot with joint aspiration and anti-inflammatory therapy. Call (810) 206-1402 at our Bloomfield Hills or Howell office.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
Frequently Asked Questions
What triggers a gout attack?
Common triggers include high-purine foods (red meat, organ meats, shellfish), alcohol (especially beer), dehydration, and rapid weight changes. Certain medications like diuretics can also trigger attacks. Tracking your triggers helps prevent flares.
What should I do during a gout attack?
Rest and elevate the affected joint. Ice (wrapped in a cloth) can reduce swelling. Anti-inflammatory medications (NSAIDs, colchicine, or corticosteroids) prescribed by your doctor provide the fastest relief. Do not start uric acid-lowering medications during an acute attack as this can prolong it.
Does gout go away on its own?
A gout attack typically resolves on its own within 1–2 weeks even without treatment, but it will recur — often more severely and more frequently. Long-term uric acid management with medication and diet is needed to prevent joint damage from repeated attacks.
Need Treatment at Balance Foot & Ankle?
Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.
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Gout & Pseudogout Treatment in Michigan
Balance Foot & Ankle provides expert management of acute gout and pseudogout flares in the foot and ankle. Our podiatrists help control uric acid levels and prevent future attacks.
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Clinical References
- FitzGerald JD, et al. 2020 American College of Rheumatology guideline for management of gout. Arthritis Care Res. 2020;72(6):744-760.
- Dalbeth N, et al. Gout. Lancet. 2016;388(10055):2039-2052.
- Rosenthal AK, Ryan LM. Calcium pyrophosphate deposition disease. N Engl J Med. 2016;374(26):2575-2584.
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.
Frequently Asked Questions
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- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)
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