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What is the Best Way to Diagnose Gout in the Foot?.m4v

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Published on Feb 19, 2012

What is the Best Way to Diagnose Gout in the Foot

Hi... I'm Dr Christopher Segler, a podiatrist in San Francisco and this video will explain the best way to diagnose gout in the foot. Gout is one of the most painful conditions that can affect your foot. Gout hurts because you actually get thousands of needle-shaped uric acid crystals inside the joint. And if you're watching this, your foot has probably become red, hot, and swollen as all of those sharp crystals have accumulated in the foot... most likely at the big toe joint. Wearing shoes is almost impossible when you have gout. In fact people who have gout will say it is so painful they can't even stand to have the bed sheets on top of their foot. They have to sleep with the feet sticking out of the covers. Because the big toe joint is so painful you really should know the best way to diagnose gout in the foot, so that you can get the best treatment.

There are really 5 ways to diagnose gout in the foot
1. Physical exam by a doctor
2. Foot X-rays
3. Blood tests
4. Joint fluid analysis
5. Cytology

When you see a podiatrist for foot pain potentially caused by gout, your doctor will ask about your medical history to find out if you have any medical conditions that put you at risk for gout.

Foot X-rays are often performed by podiatrists when there is a diagnosis of gout being considered, but this is usually to look for other conditions such as fractures. Signs of gout don't usually show up unless you have had gout crystals in your joint for years. So its not really that effective in diagnosing the gout in the first place.

A blood test called "Serum Uric Acid level" is one of the most commonly performed tests for gout. Unfortunately it isn't very reliable. It only tells the doctor how much uric acid is in your blood stream at the time the test is performed. It doesn't really tell us, whether or not there are any uric acid crystals in your big toe joint causing a gout attack.

Joint fluid analysis is another test that doctors can perform when looking for gout.
This is also know as "joint aspiration" or "arthrocentesis." To perform this test, your podiatrist makes your foot numb with local anesthetic. He can actually remove some of the joint fluid and actually see the clumps of uric acid crystals suspended in the fluid. It looks much like lumps of toothpaste suspended in the synovial fluid. You can see some of it here. At this point most doctors would call this gout. But we can go one step further.

Cytology is another test and this is where a doctor actually looks at the fluid that was taken out of the joint and examines under a special microscope that uses polarized light. The pathologist can then determine whether the crystals are needle shaped gout crystals, or if they are rhomboid shaped psuedogout crystals. If we see these needle shaped crystals...we know with 100% certainty it is gout.


To summarize

Physical exam is not the best way to diagnose gout because gout can be mistaken for other conditions, like an infection or a broken bone.

X-rays are not really a great way to diagnose gout in the foot when it first begins, because x-rays really only show long-term damage in the joint and changes that happened after the gouts has been ipresent for a long period of time.

Blood tests to look at your uric acid are often normal during an attack of gout and are highly unreliable. The reason is because the uric acid is no longer suspended in the blood...it is in the joint in the form of sharp needle-shaped crystals that are causing all of that pain, redness and inflammation.

Joint aspiration is much better for diagnosing gout simply because the doctor can actually see the material in your joint fluid that looks like gout... but it could also be psuedo-gout, so its not 100% reliable.

By far the best and MOST reliable test for gout is cytology under a polarized light microscope. It is the most accurate by far. There is just no mistaking when you see those needle-shaped gout crystals in the joint fluid.

With any condition as painful as gout its always best to have an accurate diagnosis the first time you see a doctor. With the correct diagnosis, you can then make sure that you get the best treatment and get better as quickly as possible.

Because gout in the big toe joint is so painful, we offer emergency housecalls in order to provide the best diagnosis and the fastest treatment possible in San Francisco, Mill Valley, Tiburon, Oakland and Berkeley. If you have a question about gout in the big toe joint call Doc on the Run Podiatry House Calls.

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