Gout, a type of arthritis caused by the accumulation of urate crystals in and around joints, often affects the big toe. Gout affects as many as two million Americans as of 2010, Cedars-Sinai Medical Center reports. A number of factors contribute to development of pain in the toe from gout, which fortunately is treatable and, in many cases, preventable.
Cause
Gout toe pain is caused by buildup of uric acid crystals in the blood, or hyperuricemia. Uric acid comes from the body's breakdown of purines, which are produced naturally by the body and also found in foods such as asparagus, anchovies, herring, mushrooms and organ meats, according to MayoClinic.com. Uric acid accumulates in larger than normal amounts in the body if its production rises or excretion decreases, such as in decreased kidney excretion, the most common cause, the Merck Manual reports.
Symptoms
Gout toe pain often occurs in the night, with intense pain that's worse in the first 12 to 24 hours, MayoClinic.com states, although pain can last up to a few weeks. The toe turns red, hot, swollen and tender to the touch. Some people experience systemic symptoms such as fever, chills and rapid heart rate along with gout toe pain.
Diagnosis
Gout pain in the toe must be differentiated from other types of arthritis in the toe. Palindromic rheumatism, sometimes a forerunner of rheumatoid arthritis, can cause pain and inflammation in the toe similar to that of gout, but lasts only one to three days and subsides without treatment. Fracture in a person unable to provide an accurate history, such as someone with dementia, can also be confused with gout. Synovial fluid drawn from the toe joint can be analyzed for uric crystals to make the diagnosis.
Elevated blood levels of uric acid don't always establish toe pain as gout, because many people without gout have elevated levels, and as many as 30 percent of people with gout have normal levels at the time gout toe pain develops, according to the Merck Manual.
Risk Factors
Gout toe pain more often affects men than women and those with a family history of gout. High blood pressure, use of certain diuretics, high cholesterol levels, taking low-dose aspirin, obesity, alcohol consumption and taking anti-rejection medications after organ transplant all increase the risk of developing toe pain from gout.
Treatment
Treatment for gout pain in the toe consists of medications both to treat the current pain and to prevent further attacks, as well as lifestyle changes such as reducing controllable risk factors like obesity. Medications to treat gout toe pain include anti-inflammatory medications to reduce pain and inflammation and possibly colchicine, which reduces pain but may also cause nausea, vomiting and diarrhea, MayoClinic.com warns. Oral or injected corticosteroids also help reduce pain and inflammation. Drugs that block uric acid production, such as allopurinol or drugs that improve uric acid removal through the kidneys, such as probenecid, help prevent future attacks of gout toe pain.
