Imagine suddenly waking up in the middle of the night with excruciating pain in your big toe. Walking feels impossible, and even the light pressure of a duvet against your foot is unbearable. It sounds like a nightmare, doesn’t it? Sadly, this scenario is all too real for people suffering from gout, a painful type of arthritis that commonly affects the big toe joint.

Understanding what gout is, why it happens, and how you can manage it is key to finding relief and preventing future attacks.

What causes gout?

Gout is caused by a build-up of uric acid in the blood (a condition called hyperuricaemia). Uric acid is a natural waste product that normally dissolves in the blood and passes out in urine. When too much builds up, sharp urate crystals form in joints — most often in the big toe. These crystals trigger a strong inflammatory response, leading to the redness, heat, swelling and severe pain typical of a gout attack.

Gout most commonly affects:

• The big toe (classic site of pain and swelling).
• Ankles, knees and other foot joints.
• Occasionally, hands, elbows and wrists.

Who is most at risk?

• Men over 30 and postmenopausal women.
• People with a family history of gout.
• Those with obesity, high blood pressure, kidney disease, or diabetes.
• People who consume a diet high in purines (see below).
• Anyone taking certain medications such as diuretics.

Gout is relatively common, according to the UK Gout Society, one in 14 men and one in 35 women will develop this joint disease.

Symptoms of a gout attack

A gout flare usually develops suddenly, often at night:

• Intense joint pain, most commonly in the big toe.
• Red, swollen and hot skin around the joint.
• Limited movement due to pain.
• Lingering discomfort, sometimes for a week or more.

If you experience recurrent attacks, untreated gout can cause joint damage, lumps of uric acid crystals under the skin (called tophi), and kidney stones. Early management is important.

What to do when gout strikes

If you’re in the middle of a flare-up, there are steps you can take to ease discomfort:

• Rest and protect the joint: Avoid walking long distances or putting unnecessary pressure on your big toe.
• Ice the joint: Wrap an ice pack in a towel and apply to the area for 15–20 minutes at a time to reduce inflammation.
• Elevate your foot: Raise your foot on pillows so it’s above heart level to limit swelling.
• Avoid tight footwear: Opt for open-toed sandals or cut the toe out of a sock to reduce pressure.
• Leave the joint uncovered overnight: The lightest pressure can worsen pain.

Your GP may prescribe anti-inflammatory medication, corticosteroids, or drugs to lower uric acid (such as allopurinol) to manage symptoms and prevent future attacks. More details are available on the NHS gout guidance.

Lifestyle changes to prevent gout attacks

Long-term management of gout is all about lowering uric acid levels. Small lifestyle changes can have a big impact:

1. Follow a low-purine diet

• Limit alcohol – particularly beer and spirits.
• Reduce red meat and organ meats such as liver, kidneys, bacon and game.
• Cut down on seafood like sardines, anchovies, mackerel and shellfish.
• Choose low-fat dairy products, wholegrains, fruit and vegetables, which may help protect against gout.

2. Maintain a healthy weight

Carrying extra weight increases uric acid levels and puts more pressure on your feet. Even modest weight loss can reduce flare frequency.

3. Stay hydrated

Drinking plenty of water helps flush uric acid through the kidneys and reduces the chance of crystals forming. Aim for 1.5–2 litres per day unless advised otherwise.

4. Exercise regularly

Low-impact activities like swimming, cycling, or brisk walking can support joint health without putting excessive stress on the feet.

The link between gout and over-indulgence is why the condition was known historically as the ‘rich man’s disease’. Being a healthy weight, drinking plenty of water to flush out uric acid and exercising regularly can all help you to avoid gout attacks.

Reduce the Pressure, Reduce the Pain

Gout can’t be cured, but it can be managed effectively – and ensuring that your feet receive expert care plays an important part in that process.

Our London podiatrists can help to relieve the pain caused by gout in your big toe (or elsewhere in your foot) with prescription orthotics. These custom-made shoe inserts are designed to make the affected area more comfortable by reducing the pressure it’s under. What’s more, we can offer expert advice on which shoes you’ll find most comfortable.

Podiatric padding and foot shields can be beneficial when gout strikes. In addition, if the swelling has led to sores, ulcers, calluses, etc., we can treat those issues too.

For expert help to relieve the foot pain caused by gout, please call Feet By Pody today on 0207 099 6657 or book a podiatry appointment online.