What’s Worse Than Big Toe Pain ?

For most people, gout starts with big toe pain. For many, it starts with a different joint, but your first concern is always the same – get rid of the pain.
From that moment, different obsessions kick in. Food obsessions, gout cure obsessions, and always, always keep the pain at bay.

Quite rightly, your doctor’s priority when you get an attack of gout pain, is to deal with the pain. Left untended, most pain will go away in a few days. Bad attacks may linger for over a week. But normally, the pain is so severe that you want to treat it straight away. Particularly if your mobility is reduced.

If it’s your first attack, once the pain has subsided, you need to discuss long term treatment with your doctor. If you have already arranged such treatment, e.g. allopurinol or other uric acid reducing drugs, it is vital that you continue to take them as well as pain medication.

All the above is pretty standard stuff. Once the big toe pain has gone, you’ll continue to work with your doctor and reduce your uric acid. Won’t you?

Well apparently not.

I was reminded yesterday of the abject failure of most long term gout management programs.

Many of the options help alleviate pain or possibly even prolong periods between attacks. However, NONE of the options can prevent the joint damage that uric acid deposits cause. General practitioners and Internet information often fail to stress (or even acknowledge) the implications of leaving gout untreated with medicine. Your affected joints will degenerate slowly over time and it won’t be fun.

The actions of Allopurinol and other drugs used to treat Gout are often not fully explained to patients. Allopurinol not only inhibits the production of uric acid but it also aids in the dissolving of the crystals that are already congregated in your joints. Over time, your joints get back to a healthy level of crystals – NOT a level that will destroy the joint.

Words aren’t powerful enough to stress the importance of this: If you have gout, find a good Rheumatologist and work with that person for the rest of your life. This is especially important for younger folks diagnosed with gout!

You won’t be sorry.

That heartfelt plea touched a nerve and reminded me of some of the studies I’ve seen over the past year or so. I touched on this in my December 2006 Newsletter. I mentioned a couple of statistical gout studies, the combination of which implies that only around 1 in 10 gout sufferers receive anything like proper long term gout management advice.

It is time to take a stand. Managing gout is more than treating big toe pain.

It is critical that you and your medical team monitor uric acid levels. It is critical that those levels are kept low enough to dissolve all existing uric acid crystals.

Failure to do so exposes you to the risk of joint damage, kidney stones, or both.

I am going to review all my web pages on GoutPal.com to ensure this message is clear.

I’d like to take this further, and mount a campaign for better gout treatment. I can think of many ways to promote this, but I need to get my facts straight first. I will prepare some hard hitting information about the dangers of long term joint damage from poorly treated gout, and seek some professional opinions on it. I’m thinking about simple, best practice guidelines that health care providers can follow, and gout sufferers can understand.

If you, or your rheumatologist, have any suitable information that would help me with this, I’d love to receive it.


  • ploi


    Nice too read what you know.I am only 33 and from thailand but do not know if my dad this had because i am adopted.

    I do drink a lot but average 6 cans 33ml beers but drink also a lot of water and eat no chicken anymore but pork and beef.

    i try not to eat bread and all the others but these are things that i eat sometimes anyway.
    today i had another attack in my right foot just below my big toeand took 2 tablest of colchine .

    now after 30 min the pain is a little bit less but not a lot.it started yesterday and during the nite it was the same and then when i got out of bed it was strong.

    i tried to leave it but the pain was to intense so my friend bought some colchine.1 every hour is says on the packing.

    Last time i had this was 3 months age but far worse coulndt move my right foot in total and had to go the hospital for some injection.

    This was the time i got diagnosed aswell but after some reading on the net now i know i quite serious.

    I have to back to my room now the pain is very intense and better put my foot down and watch some tv.

    thank you ,

    Ploi Thailand

  • alan

    dear sir or madam, i have just been readying about gout on your websit,to tell the truth i dont know if i have got gout in my toe or not nor dose my doctor, the pain every day is so bad that i find it hard to walk,and to sleep at night.
    I have been to my doctor’s over the last 8 months that a have had this pain, sametimes it is in my knee and the pain gose strat down to my big toe, i have been sent up the hosptail to have MRI scan’s done and i am waiting for the result’s to come back.
    I have lost so much whaight on my right leg were i am not walking right,i am just hoping that when i get these result’s back from the MRI scan that thay can do samething about it as i can’t go on much longer with the pain.
    alan from luton

  • Hi Alan,

    It’s a shame that you are suffering this way. The test for gout is really quite simple, but most GP’s (family / general practice doctors) are not aware of it.

    The best thing to do is to consult a rheumatologist, or failing that you might have luck at the emergency unit of your local hospital.

    The test is called arthrocentesis, and involves drawing a small amount of fluid from the affected joint. The fluid is examined under microscope, and will show if you have gout or not. In minutes.

    The test will also show if you have pseudogout or septic arthritis instead of gout.

    I would try to get this test done as soon as possible – i.e. don’t wait for MRI scan results, as those tests are unlikely to be conclusive for gout.

  • Gerald

    I’m 39 male. I’m going to see a foot specialist tomorrow. I had weight loss surgery in May of this year. My Dr took me off all my med’s after the surgery, including Allopurinol . I had not had an attack in almost 9 years. One month after being off the Allopurinol, I had an attack. The attack and severe pain lasted about 10 days, but I have had lingering joint pain and a red spot that has darkened, that has not gone away. Just pain when I bend my big toe joint up or down. When can I expect this ugly brownish spot to go away?

  • Luke


    I am 20 years old and believe I have gout. It doesn’t run in my family from what I know.
    My story:

    I was on a night out and drank quite alot, 15 pints of beer. I was sitting down outside having a chat and then stood up to go home, it felt like I had massive cramp in my big toe, I tred to wriggle it out, it wouldn’t work. I hobbled home in pain and disillusion as to where this came from.
    I went to bed but found it hard to sleep, I had to keep my foot outside the cover.
    When I woke up in the morning it felt like someone had crushed my toe and pulled it out of it’s socket. I got downstairs and told my mom I thought I’d broke my toe – she looked at it and she said it looked ok. It was slightly red and maybe slightly swollen, but both were very marginal if at all, I told her I didn’t kick anything, fall over or get stamped on – I didn’t, I never forget what happens even if I’m drunk. Throughout the day the pain has subsided slightly with Ibuprofen but it is still here, I cannot walk because it hurts too much, I can kind of hobble on the outside of my foot. I evidently drank alot and think this is what may have brought it on? I tend to drink that same amount every Friday, I do not drink any other time and I don’t do drugs. I do not eat seafood but I do eat alot of meat. I haven’t been able to go to the doctors as it’s closed for the weekend. I alot of exercise and am well within my BMI for my age and height. I had a cold this week if that may have brought it on? I also was dancing all night and seemed to sweat alot – a reason why I drank so much was because I got so hot.

    I don’t know whether I’ve got gout and was wondering if you could tell me from what you’ve read? Also, I’ve read that gout comes back but am a little disillusioned, with what I’ve read on the net – it seems that gout is a disease you have for the rest of your life and even by eating “perfectly” and following all these rules you will still have it but the frequency of attacks will be less. This makes little sense to me as surely if you kept the Uric acid down to a minimum then you can’t get gout (unless you have a kidney problem). Am I wrong in this assumption? Can anyone get gout if they overindulge or is it only the unlucky few who get it – seemingly if they overindulge or not!


  • matthew

    it would grate if there could be just one definitive list of what food cause the build up of uric acid as im tired of being told so many conflicting things of what to eat and what not to eat as i think diet alone will stop gout .

  • bennie

    it has been my experience that different things can trigger the episode of gout attack, some people may not be able to eat certain things beef, gravies some veggies, there are MANY things that can cause a gout episode, but i find that plenty of water will help keep the body flushed, that will help. when you first feel the slight tingle of pain take 2of the colchicine tablets and 1 600 or 800 milagram ibprophen that will start working to start to lower the uric acid level and reduce pain due to swelling, every2 hour. the take 1 colchicine and one ibprophen this will help in not allowing the gout to fully flair up, it works for me. i have had bouts with the gout for several years it is treatable but you must monitor closely what you EAT and DRINK as this is ONE of the main causes.

  • Thank you for all your comments.

    If you are looking for what stops gout pain, please consider GoutPal’s Stop Gout program for a personal gout treatment plan.

    This discussion is quite old, and has lost it’s focus.

    I will close it now, but please feel free to continue discussing big toe pain, or any other aspects of gout, in the gout forum.

Comments are closed.