What To Know About Gout in the Ankle

Gout in the ankle occurs if gout symptoms, such as sudden pain and swelling, affect the ankle. Gout is a type of inflammatory arthritis, or a condition in which the immune system has a strong reaction. Arthritis causes the immune system to attack otherwise healthy joints, leading to inflammation.

Gout occurs when the body has too much uric acid, a waste product. Flares can last from days to weeks and usually affect one joint at a time. You can typically treat gout in the ankle with anti-inflammatory drugs. It's important to prevent flares with diet and exercise. Gout may lead to joint damage and reduced mobility if left untreated.

As many as 4% of people have gout, which can affect the ankles. Read on to learn how to tell if you have gout in your ankle, as well as how to treat and prevent flares.

Symptoms of Gout in the Ankle

Gout in the ankle can sometimes be difficult to identify. It's easy to confuse it with an ankle sprain or strain. Gout in the ankle occurs without a prior wound, unlike ankle injuries.

Ankle gout symptoms, which usually come on quickly, include:

• Heat
• Intense pain
• Redness
• Swelling

Causes

The underlying cause of gout in the ankle is the same as gout in other joints. Gout occurs when excess uric acid builds up at a joint and triggers inflammation. Uric acid is a waste product of your metabolic process.

The body produces uric acid after breaking down organic compounds called purines during metabolism. Purines are found in the body and in purine-rich foods, like red meat and some seafood. The body usually transports uric acid from the bloodstream to the kidneys, discarding it in urine.

Hyperuricemia can sometimes occur. This condition happens when too much uric acid is in the bloodstream, either from a high-purine diet or because the kidneys aren't removing it properly. Not all cases of hyperuricemia lead to gout. Some people with hyperuricemia can develop gout when uric acid crystals build up at specific sites in the body. Gout in the ankle occurs when uric acid crystals become lodged in the ankle.  

Risk Factors

Men are three times more likely to experience gout than women. Estrogen, which is a female sex hormone, is protective against high levels of uric acid in the bloodstream.

The risk of gout also increases with age. Men older than age 40 or women who have gone through menopause, or when estrogen has declined, are more likely to develop gout.

Other risk factors include:

• A family history: This may predispose an individual to develop gout.
• Alcohol: Excessive amounts of alcohol can reduce kidney function, and some drinks, particularly beer, are also rich in purines.
• Diuretics: These drugs, also known as water pills, are intended to help the body discard more fluids but can also increase gout risk.
• Health conditions: This includes heart disease, high blood pressure, metabolic syndrome, diabetes, and poor kidney function.
• High consumption of added sugars: These can be found in foods and drinks like those with high-fructose corn syrup.
• High-purine diet: This includes food like red meat, organ meat, or seafood like anchovies, sardines, mussels, scallops, trout, and tuna.
• Obesity or being overweight: The body may produce more uric acid and have more difficulty discarding it.
  

Diagnosis

If you suspect you have gout in your ankle, visit a healthcare provider. They will likely refer you to a rheumatologist (who specializes in inflammatory diseases) for diagnosis and treatment.

A rheumatologist may use the following tools when diagnosing gout in the ankle:

• Blood test: Detects elevated levels of uric acid in the blood
• Joint fluid analysis: Checks the joint fluid for uric acid crystals
• Medical history: Learns about your family history and health risk factors associated with gout
• Physical exam: Examines the ankle joint and rule out other possible causes of the pain and swelling
• Ultrasound, X-rays, or other imaging tests: Looks for uric acid build-up in the joint

Gout in the Ankle Treatment

Gout is one of the most manageable types of arthritis with early intervention and treatment. A healthcare provider can likely help manage your condition once a diagnosis has been made.

There's no cure for gout, but treatment options are available to reduce symptoms. Managing a flare involves reducing pain and swelling.

A healthcare provider may recommend some of these common treatments depending on your symptoms and existing conditions:

• Allupurinol, which reduces uric acid levels in the blood
• Biologics
• Colchicine, an anti-inflammatory prescription drug
• Corticosteroids, which are anti-inflammatory steroids
• Elevation
• Ice
• Methotrexate, which suppresses the immune response
• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen
• Rest

Gout symptoms usually subside and resolve on their own after a few days to weeks. Treatments can help with discomfort. A healthcare provider may prescribe medication that reduces uric acid build-up if you have recurring gout flares.

Prevention

Making lifestyle changes that reduce excess fat and high levels of purine can reduce the risk of gout. This can include exercising regularly, maintaining goal weight, and limiting alcohol intake and purine-rich foods.

Following specific diets might also lower your risk of gout. Before you make any changes, talk with a healthcare provider about developing an individual prevention plan.

A 2020 study of more than 44,000 men estimated that following a DASH diet could prevent up to 22% of gout flares. DASH, which stands for Dietary Approaches to Stop Hypertension, was developed to manage high blood pressure. This diet consists of vegetables, fruits, whole grains, lean protein, low-fat dairy, nuts, and beans. DASH also limits red meat, fatty meat, and sugar-sweetened foods and beverages.

Some evidence suggests that low-fat dairy products, coffee, and vitamin C are each associated with a lower risk of gout. They may help the kidneys discard uric acid from the body.

Complications

Most gout attacks peak about 12 to 24 hours after they begin. Symptoms usually slowly get better in one to two weeks, with or without treatment.

Some people may only have one gout flare in their life. Other people may experience a gout flare in the same joint multiple times. This is known as a recurring flare. Between recurring flares are periods of remission, when there are no symptoms for weeks, months, or even years before the next flare.

People with recurring gout flares can experience more severe complications, such as:

• Joint damage: Gout causes long-term inflammation. Inflammation can break down the bone and cartilage in your ankle, causing joint damage.
• Reduced mobility: Mobility is the ability to move your joints freely. Inflammation, pain, and swelling can reduce this range of motion.
• Tophi: If left untreated, recurring gout flares can develop tophi. Tophi is late-stage, severe gout that appears as lumps under the skin and can permanently damage the joint.

A Quick Review

See a healthcare provider if you suspect you may be experiencing gout in the ankle. A flare usually resolves on its own, but there may be medications that reduce the pain and swelling.

There's no cure for gout, but it can be successfully managed. Focus on healthy lifestyle changes to lower your risk of ankle gout or any other gout flare. Meeting with a healthcare provider or a dietician may be helpful for addressing gout over the long term.