Hey, now that you have seen the Superbowl, eaten shrimp, hot wings, pepperoni and cheese platter, where are you going now? To the podiatrist!!!

Some people, more likely men, will experience terrible pain after a rich and high protein diet. This diet can consist of shellfish, oily fish, beef, pork, organ meats, cheese, and alcohol.  The pain is usually in the big toe joint but it can be present throughout the lower extremity. This is a condition known as gout.

Gout is a systemic condition that patients will acquire after eating a rich diet consisting of proteins. Alcohol can precipitate a gouty attack. Even some medications can cause this painful condition.

This condition is cause by an elevation of uric acid, which is a by-product of protein breakdown. This “by-product” can precipitate in cold joints like the big toe joint, ankles, knees, elbows, and ear lobes. It analogous to pouring sugar into cold water and the sugar does not dissolve. Well, the uric acids are crystals that can invade the big toe joint and the body will react to it like a foreign body. By the same token, the joint will become very hot and swollen. Also, it will become very painful to the point that bed sheets cannot be tolerated.

The patient usually presents in the office with a severe limp and pain. Upon examination, the toe joint cannot be touched. Some patients will say they injured it with no recollection of trauma. Also, some will say it is an infection. An x-ray is taken to make sure there is no trauma or infection.

Treatments for this condition are oral and injectible steroids, aspiration of the joint fluid for lab analysis for gout. In addition, blood work is a good diagnostic indicator for uric acid levels; however, this should be done within the first 24 hours of the attack. Oral medications are used for the acute gouty attack and anti-inflammatory or pain medications. Recommendations are for follow-up with the primary care doctor for medications to prevent reoccurrence.

Elevated uric acid levels do not cause gout but can initiate the processes. Many patients will go untreated and this is bad. The crystals can cause “tophi” which are crystals that will present beneath the skin like a cheesy substance and this can present everywhere. Also, gout can cause kidney stones and cause damage. Gout should be addressed by a podiatrist for acute symptoms and the family doctor for systemic symptoms. The systemic symptoms can be genetic where the factor or enzyme that breaks the uric acid down may be missing.

So, if you get that severe pain after that seafood, beefy treat and then washing it all down with a cold brewski, chances are it is GOUT.

By Dr. Jasen Langley