Gout of the toe is a painful condition caused by buildups of a substance called uric acid in joint fluid and soft tissues. Excess uric acid crystallizes in and around the toe joint, leading to inflammation, redness, and tenderness. There are two possible reasons for uric acid buildup: either the body produces too much of it, or not enough is processed by the kidneys and expelled through urine. Risk factors for developing gout of the toe include a family history of the problem, excessive alcohol consumption, eating a lot of red meat, and taking medications for high blood pressure.
Uric acid is a natural end product of purine metabolism. Purines are important chemicals that act as an energy source for the body's cells. When purines made by the body or ingested with food are broken down, uric acid is produced as waste. The kidneys normally process uric acid quickly so it can be removed from the body as urine. Gout of the toe or other joints such as the ankle, knee, or hand usually occurs when there is a problem expelling the acid.
A person's kidneys might have trouble getting rid of uric acid if he or she has a chronic renal disease or kidney cancer. Traumatic injuries to the kidney region or complications of surgery lead to poor renal functioning as well. Other potential causes of acid excretion problems and resulting gout of the toe include dehydration, malnourishment, and alcohol abuse.
A small number of cases of gout of the toe do not arise because of under-excretion. The problem instead is that there is too much uric acid in the bloodstream for the kidneys to handle. In some cases this can occur due to genetic disorders that cause the body to create more purines than normal. Frequently consuming foods that are high in purine, such as red meat, organ meat, fish, and yeasty products can raise uric acid levels as well. Diuretics, drugs that increase urine production, also may result in high uric acid because the urine output is mostly water.
It is important to seek medical attention whenever gout of the toe develops so a doctor can check for underlying causes and recommend an effective treatment. Blood, urine, and joint fluid samples are usually taken to assess the amount of uric acid present. Imaging scans and other tests are used to look for kidney and thyroid disorders, genetic conditions, and signs of trauma. Depending on the cause, a person may need to take medications to block acid production or enhance the kidney's ability to remove waste. With anti-inflammatory drugs, proper hydration, lifestyle changes, and rest, most people are able to overcome gout attacks and prevent future issues.