Best 5 Ways to Fix Gout

Gout is a painful inflammation in the joint. Did I say painful? I meant, REALLY PAINFUL! It’s often described as being excruciating, keeping patients up at night, and making it difficult to walk on.

When my wife had gout in her big toe, she was in a lot of pain. She was hobbling, unable to walk long distances, and limped into work. Her big toe was red and swollen, and very painful to touch or move.

Sometimes people find it hard to tell if they have gout, or a joint injury, or arthritis. Gout tends to come on quickly and rapidly get worse. A joint injury to the big toe or knee (two of the most common joints affected) tends to be caused by trauma, so the cause is clearer. Arthritis tends to come on slowly, and be less acutely painful.

The joint pain in gout is primarily caused by the deposition of urate crystals within the joint space. Here's how it happens:

High Levels of Uric Acid:

Gout is directly related to excess levels of uric acid in the blood. Uric acid is a waste product formed from the breakdown of purines, substances found naturally in your body as well as in certain foods. This can be caused by poor diet, genetics, kidney issues, and medications (diuretics, aspirin, chemotherapy drugs, immunosuppressants). Alcohol is also a big issue.

Formation of Urate Crystals:

When uric acid accumulates in the blood and reaches a certain concentration, it can crystallize, forming needle-like monosodium urate (MSU) crystals. These crystals tend to deposit in cooler parts of the body, which is why the big toe is a common site for gout attacks, though other joints can also be affected.

Immune Response and Inflammation:

The presence of MSU crystals in the joint triggers an immune response. White blood cells engulf the crystals, which leads to the release of chemical messengers called cytokines and other inflammatory substances. This inflammatory response causes the characteristic symptoms of a gout attack: intense joint pain, swelling, redness, and warmth.

Pain

Then follows the pain. As we discussed earlier, it tends to be excruciating.

How to fix Gout

1. Prevention is better than cure

Gout can be on/off chronic. It can come and go. This means that often prevention is better than cure. That may not be too helpful if you are reading this and suffering with gout right now, but it may be helpful if your gout goes away, you can prevent it from coming back. Diet and lifestyle choices are the key factors that we’ll explain shortly.

2. Steroid injection / Cortisone Injection

We provide cortisone (steroid) injections at Surrey Physio. They can really help with gout, because the inflammation is so acute and steroid is a strong anti-inflammatory. Generally, people come to see us when they’ve tried other things, and they are just not getting anywhere. We will carefully place a steroid with anaesthetic into your big toe (or knee, or another gouty joint). It’s uncomfortable, but patients tell us that nothing is worse than the pain of gout, so actually it’s quite tolerable. The injection is over in a few seconds, and within a few hours you should start to notice less pain and inflammation. Call us about having a steroid injection – we do them in Farnborough and Croydon.

3. Diet

Avoid all alcohol. This is because alcohol metabolism in the liver produces purine compounds that get made into uric acid for excretion. Also, excessive alcohol can impair kidney function, and kidneys are essential at filtering uric acid. Beer is particularly high in purines, and both cheap wine and beer can be problematic. Alcohol can also mess with medications you might be taking. Fasting can help too, as it rapidly reduces toxins in your body. Of course, weight loss is always advisable if you are overweight. My wife’s top tip: cherry juice. We bought organic pressed cherry juice from Biona. Cherry supplements might help too. My wife also suggests high dose vitamin C.

Also flush your body with good quality water. Drink plenty of it. Avoid sugary drinks and whatever you do, stay away from Monster, Redbull and coke.

4. Exercises

Gentle mobility exercises are very helpful. For example, just bending your big toe back and forth. Or bending your knee and straightening it.

Physiotherapy including ultrasound and acupuncture may help in some cases. We use passive mobilisation to the toe, to gently move it, and also electrotherapy to help reduce pain and inflammation. We will also design a customised exercise program to gently mobilise your big toe (or knee).

5. RICE

Rest, Ice, Compression, and Elevation (RICE) can help reduce pain and inflammation associated with gout. Although often compression can be too painful, so if that’s the case, just elevate rest and ice it. Applying ice packs (wrap in a towel) for 10 minutes twice to three times per a day can help reduce swelling and pain.

Conclusion

Managing the factors that lead to high levels of uric acid can be an effective way to prevent gout, or to reduce the pain if you get gout. This can include making dietary changes, managing weight, staying hydrated with plenty of water, controlling health conditions with appropriate treatments, and adjusting any medications that might contribute to high uric acid levels under the guidance of your GP.

(Therapists, osteopaths, sports therapists, chiropractors reading this page… if you love the exercises here, then please check out the amazing exercise prescription tool www.rehabmypatient.com. You can sign up for a free 14-day trial, and it’s affordable to buy, with pricing starting from £11.23 per month.

If you are a patient and struggling to walk due to painful gout, please call us to discuss your case further. Surrey Physio have an amazing team of therapists that can help you rehab to get back on your feet exercising or walking better once the pain reduces. We’re here to help you recover from pain, and get you back to living a normal life. Call us on 0208 685 6930 or click the link at the top to book online.)