What is the Best Way to Diagnose Gout in the Foot?
Hello … 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. The gout hurts because thousands of crystals of uric acid in the form of a needle are actually obtained inside the joint. And if you are looking at this, your foot has probably become red, hot, and swollen as all those sharp crystals have built up in the foot … most likely in the joint of the big toe. The use of shoes is almost impossible when you have gout. In fact, people who have gout say that it is so painful that they can not even have bed sheets on the top of their foot. They have to sleep with their feet coming out of the decks. Because the big toe joint is so painful you really should know the best way to diagnose gout in the foot, so you can get the best treatment.
There are actually 5 ways to diagnose gout in the foot
1. Physical Examination of a Physician
2. X-ray of the foot
3. Blood tests
4. Analysis of joint fluids
When you see a foot podiatrist who is potentially caused by gout, your doctor will ask about your medical history to find out if you have any medical condition that puts 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. Drop signs usually do not show up unless you have had drop crystals on your board for years. So it's not really that effective in diagnosing 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 is not very reliable. It only tells the doctor how much uric acid is in your bloodstream at the time of the test. It really does not tell us, whether or not there are uric acid crystals in the big toe joint causing a gout attack.
Joint fluid analysis is another test that doctors can perform when looking for gout.
This is also known as "joint aspiration" or "arthrocentesis". To perform this test, your podiatrist causes your foot to numb with local anesthesia. Actually, you can remove part of the joint fluid and actually see lumps of uric acid crystals suspended in the liquid. It looks very much like the lumps of toothpaste suspended in the synovial fluid. You can see some of this here. At this point most doctors would call this drop. But we can go a step further.
Cytology is another test and this is where a doctor actually looks at the fluid that was removed from the joint and examined under a special microscope that uses polarized light. The pathologist can then determine whether the crystals are needle-shaped drop crystals, or whether they are rhomboid formed psuedogout crystals. If we see these crystals in the form of a needle … we know with 100% certainty that it is gout.
To sum up
Physical exam is not the best way to diagnose gout because gout can be confused with other conditions, such as infection or broken bone.
X-rays are not really a great way to diagnose gout in the foot when it first starts, because x-rays actually only show long-term damage to the joint and the changes that happened after the gout have been ipresent for a long period of time.
Blood tests to look at your uric acid are often normal during a gout attack and are highly unreliable. The reason is because uric acid is no longer suspended in the blood … it is in the joint in the form of sharpened needle-shaped crystals that are causing all that pain, redness and inflammation.
Joint aspiration is much better to diagnose gout simply because the doctor can actually see the material in your joint fluid that looks like gout … but it could also be psuedo-drop, so it is 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 simply no doubt in seeing those needle-shaped drop crystals in the joint fluid.
With any condition as painful as gout it is always better to have an accurate diagnosis the first time you see a doctor. With the correct diagnosis, you can ensure that you get the best treatment and get better as fast as possible.
Because gout in the big toe joint is so painful, we offer emergency services to provide the best diagnosis and the fastest possible treatment in San Francisco, Mill Valley, Shark, Oakland and Berkeley. If you have a question about gout in the joint of the big toe Doc in the performance podiatry house calls.
Video credits to sanfranciscopodiatry YouTube channel