A real pain in the toe

Are you suffering from gout? Have this red flag checked out.

Tuesday, July 25 2023

If you have ever felt the hot, searing pain and swelling caused by gout, you will know that it can be surprisingly disruptive to daily life particularly for a condition generally limited to one small area of your body – such as your big toe, as is often the case.

“Gout can easily be misunderstood as simply being a reaction to overindulging in food and alcohol. But it is important to be aware that, while closely linked to what we ingest, gout is a type of arthritis affecting the joints and can be a red flag for related conditions. Early intervention is therefore key to managing your overall health better,” says Dr Cathelijn Zeijlemaker, Medical Director at Netcare Medicross.

“Painful gout attacks can happen quickly and over time chronic gout can develop, with attacks affecting more joints and becoming more frequent. Gout can also cause uric acid to build up under the skin and even inside the kidneys. If left unaddressed, it can cause long term damage.”


What does gout point to?
Dr Zeijlemaker notes that if there is a build-up of uric acid – a chemical formed by the breakdown of purines, a natural substance found in certain foods and drinks – gout can occur. While purines are important for building body proteins, when the body has too much uric acid, sharp crystals can form and build up inside the joints causing pain and swelling.

“The most common cause of gout is the kidneys not removing enough uric acid from your blood, which may indicate the potential for kidney disease and must be investigated. Gout can also occur with certain cancers and cancer treatments, or with a diet high in purines. In addition, trauma or stress are noted triggers of gout attacks.

“Age and sex are also factors in developing gout, which typically affects men between 30 to 50 years of age. Women are generally less affected by this form of inflammatory arthritis, although those who are going through or have gone through menopause are more at risk,” she says.

Additional common risk factors to be aware of include conditions such as obesity and taking certain medications including aspirin, diuretics and others. Kidney disease, lead poisoning and a skin condition called psoriasis are also linked to gout, as are rapid weight loss, dehydration, the frequent consumption of alcohol, especially beer, and beverages sweetened with a type of sugar known as fructose.

Managing gout holistically
According to Dr Zeijlemaker, careful management of your weight and diet is foundational to keeping gout under control, and foods such as liver, kidney, anchovies, asparagus, herring, mushrooms, mussels, and beer – all of which contain purines – should be avoided.


“While there is no cure for gout the condition can be kept in remission with allopurinol, a medication that decreases the uric acid produced by the body in conjunction with a healthy lifestyle. Proper management of any other pre-existing conditions should also be adhered to.

“When a gout attack does occur a two-phased approach is recommended, first to address the pain and inflammation of the acute attack and thereafter to prevent the development of chronic gout and any future attacks. Medication to reduce pain and swelling will be prescribed and may include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Other treatments may be colchicine tables or steroids. If this is not suitable an injection with steroids into the joint may be considered. Additionally an ice pack applied to the affected joint may also assist to relieve the pain.

“Once the attack has settled your doctor may ask you to do a blood test to measure your uric acid levels and do further assessments to understand the severity of the gout and possible causes. It may also be necessary to start medication to lower the urate levels to prevent gout attacks in the future.”

Dr Zeijlemaker recommends consulting a dietitian about what to eat and drink to further prevent gout flare-ups, and to ensure that if weight loss is required, it is done safely.

“If left untreated, the consequences of gout can be dire leading to joint damage that may require surgery while complications in the kidneys can introduce an entirely new set of concerns. However, the good news for the many people living with this condition is that if diagnosed and treated early on in conjunction with healthy lifestyle choices, you can lead a normal, active life,” she concludes.

Notes to editor

Looking for a medical appointment? Netcare appointmed™ will make appointments for YOU with specialists practising at Netcare hospitals, GPs and dentists at Medicross medical and dental centres, and specialists at Akeso mental health facilities. Simply request an appointment online at or phone Netcare appointmed™ on 0860 555 565, Mondays to Fridays between 08:00 and 17:00.
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