Gout is a common inflammatory condition that often affects joints like the big toe. Other common sites include small joints of the feet, elbows and knees. It is one of the most painful acute arthritis conditions caused by a build up of uric acid in the blood stream. As a result of the high levels in your body, deposits of uric acid crystals accumulate around a joint causing pain and swelling.

De Quervains tenosynovitis

Symptoms of Gout


An acute attack of Gout can be incredibly painful and is often associated with redness and heat over the affected area. You may have woken suddenly in the middle of the night with severe pain in the big toe joint and even the pressure of the bed sheet on the foot is painful. Often it may not fit a normal mechanical pattern in that you did not do excessive exercise or injure the joint in anyway and the symptoms have “come out of the blue”. 

Causes of Gout


There are common triggers for gout. These include: 

  • Excessive Alcohol intake
  • Red meat
  • Shellfish
  • Fatty foods
  • Dehydration

You are more likely to get gout if: 


In the 40s

You are overweight

Have other health complications like diabetes, high cholesterol or high blood pressure and are on diuretics. 

You regularly consume alcohol



    The big toe is  often affected in Gout. The metatarsophalangeal (MTP) joint of the big toe, is the most likely affected joint. This is the “ball of the foot” and will be painful on bending the big toe eg with walking. It is the joint located between the first matatarsal bone and the proximal phalanx.

      How to diagnose


      It is important we understand the diagnosis in the first instance before implementing treatment. Your GP may perform a blood test to check your Uric acid levels in the blood stream or we may aspirate the painful joint (removing some of the fluid) and send it off to the lab for testing. Once gout is confirmed , we can then decide on the best treatment for you. 

      During your assessment with us, we will ask questions about lifestyle, diet and if you have had gout before. If you have and the symptoms are the same and in the same place, it is likely it is an acute flare of gout again. The clinician will also perform an ultrasound scan to assess the joint and look for inflammation within the surrounding tissues. If it is clear that gout is the diagnosis, then we may offer a steroid injection to help relieve the pain. 

      Gout Treatment


      Management includes taking painkillers like paracetamol and NSAIDs (Non steroidal anti-inflammatory drugs) like ibuprofen or your GP may prescribe another NASID like Naproxen. 

      There are other medications too. Colchicine is a medication that is used in serious Gout attacks. It is only taken for a few days as it can be toxic if you take it for too long. If you are consistently having attacks of gout despite adjusting your diet, then your GP may suggest Allopurinol as a long term medication solution to reduce uric acid levels in the blood stream.

      The best way to manage gout is to prevent it in the first place! Managing your diet is a big part of the treatment.

      It is important that you: 

      • Don’t eat lots of big fatty meals and especially reduce red meat and shellfish intake. 
      • Drink more water to stay hydrated- Avoid sugary drinks
      • Exercise regularly to reduce your weight
      • Don’t drink excessive amounts of alcohol

      When you have an acute attack, it is worth noting what your diet was like immediately prior to the flare. If you know your trigger, it is easier to avoid having too much of that in future. 

      Gout Steroid Injection Therapy


      If symptoms have not improved with medications and pain is still severe, then you may want to consider an ultrasound guided steroid injection.

      An ultrasound-guided steroid injection into the affected joint is a powerful way to reduce pain and inflammation. It does not replace general lifestyle changes in prevention of the condition but should give you quick symptomatic relief.

      If you are experiencing an acute attack of Gout symptoms similar to those described above and want to find out if a steroid injection is suitable, please get in touch and one of the team will assess, diagnose and advise on the best treatment option for you. Please contact us on 0207 636 5774 or email reception@oxfordcircusphysio.co.uk