Red, Throbbing Big Toe: What Could it Mean?

You wake up in the middle of the night to find your big toe red and throbbing with pain. What’s going on? Most likely, you’re dealing with one of the 100-plus forms of arthritis, specifically, with gout. While gout can affect any joint, it most commonly starts in the big toe.

At Chicagoland Foot and Ankle, our board-certified podiatrists diagnose and treat gout in our offices in and around Chicago, Illinois. If you’ve suddenly experienced this incredibly painful condition, here’s what you need to know about keeping it under control.

What causes gout?

Gout develops when uric acid crystals collect in the joint space. These crystals form when you have high levels of uric acid, a breakdown product of purines, in your blood. 

Purines are found naturally in your body, as well as in certain foods and drinks, such as red meat and organ meats; seafood; alcohol, especially beer; and drinks sweetened with fructose.

Gout was once referred to as the “disease of kings,” because only the wealthy could afford the rich meats and expensive drinks associated with it.

Normally, uric acid dissolves in your blood; your kidneys process it, and then expel it from your body with urine. 

But if your body produces too much uric acid, or if your kidneys can’t process the large amount consumed, the acid builds up, forming sharp, needlelike crystals in the joints or surrounding tissue that produces pain, inflammation, and swelling — gout.

Gout occurs more often in men, as women usually have lower uric acid levels until after menopause. Men also develop gout earlier than women, usually between 30 and 50 years. Women don’t generally reach menopause until they’re 50 or older.

Gout symptoms

Gout symptoms almost always appear suddenly, and often during the night. They include:

• Intense joint pain that’s most severe within the first 4-12 hours
• Lingering discomfort lasting days to weeks
• Later attacks that last longer and affect more joints
• Inflammation and redness in the affected joints
• Limited range of motion

Weight also plays a role in gout flare-ups. If you're overweight or obese, your body produces more uric acid, and your kidneys can’t eliminate the uric acid as effectively.

Treating gout

Gout treatment generally includes a combination of medication and lifestyle changes.

Medications

Medication to treat gout flare-ups and prevent future attacks may include:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

These include both over-the-counter and prescription versions, both of which can lead to stomach pain and gastric ulcers if used excessively.

Colchicine

Known by the brand names Colcrys®, Gloperba®, and Mitigare®, colchicine is an anti-inflammatory drug that reduces gout pain. It’s not ideal for everyone, though, as it comes with side effects that include nausea, vomiting, and diarrhea.

Corticosteroids

These medications control gout inflammation and pain and come in both pill form or as an injectable into the joint. Side effects of the oral form include mood changes, increased blood sugar levels, and elevated blood pressure; the injectable only acts locally.

Lifestyle changes

Lifestyle changes can control gout flare-ups and prevent future attacks. Dietary changes include:

• Avoiding shellfish, gravies, red meat, and organ meats
• Limiting alcohol, especially beer
• Avoiding drinks high in sugar or fructose

Because weight affects gout, it’s important to lose extra pounds and maintain a healthy weight. If you can’t do this on your own, there are medically supervised weight loss programs that can help.

In addition, gout is often associated with high blood pressure, cardiovascular disease, and kidney disease, so in addition to podiatric treatments, your primary care provider or rheumatologist may become involved to oversee these health problems.

If you suddenly wake up with a red, throbbing big toe, it’s probably gout, and you need medical attention. Call any of our Chicagoland Foot and Ankle locations (Mount Greenwood and Portage Park areas of Chicago, as well as Orland Park, Bartlett, Niles, and New Lenox, Illinois) to schedule a consultation, or book your appointment online today.