Gout sufferer loses both big toes. Now what?

As a long-time gout sufferer, I’ve often wondered about this. Do gout attacks then occur in the joints of the next biggest toes? While I’m here, what’s with the gout/big toes connection, anyway? Why do gout attacks nearly always occur there? I mean, I had a gout attack once in an ankle, but stuff like that seem to be pretty atypical. What’s the deal?

Not looking for advice, mind you; my allopurinol is treating me right. Just askin’, is all…

Yes, if the diet isn’t addressed, gout will begin to express in other areas of the body, generally in joints, tendons and the surrounding tissues. While the big toe is the most common (for unknown reasons), people also get gout in heels, fingers, toes and wrists. Yours is actually the first ankle I’ve heard of, so I guess I’ll add it to the list.

He’s also going to need a LOT of physical therapy to learn how to walk again. The big toe is very important in maintaining balance, and to amputate a big toe at the metatarsal-phalangeal joint (the one closest to the ball of the foot) will screw you up pretty badly.

But, in reality, amputation is not a treatment for gout unless there are other complications like necrotizing fascitis. Diet changes and medication are the treatments for uncomplicated gout.

Oops, perhaps I should clarify: when I referred to losing the big toes, I wasn’t referring to any treatment or effect of gout; rather, I was asking if, say, a gout sufferer lost his toes in an un-gout related accident, what would then happen?

As for my ankle, I have to say I was pretty sure it was gout (up to that point, I had already had many gout attacks in the traditional big toe region) that was haunting me, since I had not twisted my ankle in any way prior to my pain (I woke up with it), I hadn’t slept on it funny, and the pain did not resemble any pain I had ever felt previously in my ankle. Gout got my vote.

I’ve had gout for about 11 years now (first attack was when I was 31). Funny thing is, I don’t eat any of the stuff that supposedly leads to attacks. So, changing my diet was unnecessary since there was nothing in my diet that was suspicious. However, I have been on allopurinol for the last 2 years and it has kept my attacks at bay. Not all my attacks were in my toes. I had several in my knees. Thankfully, I have never had attacks in more than one joint at a time. My old boss once got it in both knees at the same time and couldn’t walk at all. Read up on gout websites. I got a lot of my information from googling gout.

My gout attacks are rarely in the big toe. I often have them in the ankle, in “hidden” joints that don’t actually bend, and in my knee.

An article in today’s Parade magazine suggests gout is most often in the lower extremities because blood (and, presumably uric acid) tends to pool there.At any rate, I’ve never had gout above the waist.
If you lost your big toe, there’s no reason you couldn’t get gout in another joint. There’s no reason you couldn’t get it in another joint now.

Both knees? Yikes! :eek: I thought I’ve had it bad.

The ankle attack I had was weird. The pain level was not as high as my toes had ever been, but at least with big toes you can walk on the outer part of your foot. With my ankle, there was no escaping pain if I wanted to move around.

My late father’s got ya beat. He once told me he had a gout attack on his honeymoon with my mom. He would’ve been around 21 or 22, I think; I don’t think allopurinol had come out yet. Even after it came out, he didn’t start taking it as he got treated by a doctor who didn’t believe in allopurinol, and who kept prescribing drugs that didn’t work. Back then, people didn’t question doctors like they do now, so my dad kept suffering; in telling me this story, many years later, he still angrily gritted his teeth.

Eventually, he switched doctors and started taking allopurinol. Took it for at least 35 straight years.

I recently woke up with tremendous ankle pain. The next day I could barely walk on it and it swelled up like a grapefruit. I went to the doc and she took fluid from the ankle. It was negative for gout and infection, and an x-ray showed no signs of an acute arthritic response (which was my guess, being a catcher for about 15 years.) The swelling and pain went down by about 50% the next day and things were about back to normal the day after that.

My doc was interested in tracking down the cause, but I didn’t really care to do more testing, and at the end the best guess was some sort of insect/spider bite.

I suffer from gout, and have had an attack in my right knee, though usually they are in toe joints and ankles.

I have a prescription for indomethicin for flare-ups. I need to be on allopurinol, but I need to find a doctor who will write a long term prescription. I haven’t had medical insurance for decades, and can’t afford to go back to get a new prescription every month.

I’ve read those gout forums and they have a huge amount of silly stuff, like drinking cherry juice. In my experience, gout attacks are directly related to not drinking enough water. If I’m thirsty one day, or am working in heat and sweat more than I can replace, I’ll have a gout attack the next day. The only way to choke down cherry juice is to wash it down with plenty of water - and the water is what you need.

Personally, if I can drink enough water that my urine is consistently clear, I’ll not have an attack.

We were taught, and still teach, that gout tends to affect those parts of the body with the lowest temperature. As a result, the ‘classic’ sites for gout tend to be furthest away from the bulk of the body and its heat, e.g. the big toe, ear lobes, elbows, etc.

I remember reading about this notion here. Unfortunately, not even the article’s abstract is on-line. Likewise, it’s not to be found on Google Scholar.


No joints in the ear lobes. I can’t see how you can have gout there when gout is pretty much defined as a joint pain problem or “a form of arthritis”.

And I’d hate it if I had gout-like pain in my earlobes, I have no doubt.

I can believe someone having gout in the elbows, but I’ve never experienced it, nor have I heard about it from any other gout-sufferer.

Let me clarify.

The ear lobes are a common site for so-called gouty tophi (singular = tophus) to form. It’s actually not at all unusual. Its deposition there doesn’t elicit inflammation, so you’re right, there are no attacks of gout in the ear lobes.

Tophi are just collections of uric acid with some occasional white blood cells (trying to clear up the mess).

Here’s a picture of an ear tophus. And another.

ETA: Here’s a more common site for tophi.

Toes, ankles, knees, elbows, achilles tendon and fingers. It’s hit them all in my case. Sometimes it moves from joint to joint. Just as it eases in one joint, another will flare up. Wandering gout, I guess.

The worst is when it hits my elbows, since those don’t seem to respond well to anti-inflammatories (in my case). The fluid build-up in the elbows can be excruciating.

And the side effects of allopurinol are severe for me, so no help there.

I agree with the poster who said diet doesn’t seem to have much of an effect. I have a pretty healthy diet, and still get the attacks. The one diet-related thing I’ve noticed is that liquor consumption in excess can trigger an attack. Beer not so much, it seems. But then I drink very rarely, so none of that is much of an issue.

The common denominator for me is stress. Anytime I am under a lot of pressure, I can be pretty sure gout will be along soon to make things worse.

When I eliminate the stress, I can go for months and months with no problems.

Gout sufferer here: first attack at age 28. I’ve had episodes in both knees, both ankles, and big toes, and I won’t say the thought of amputation hasn’t crossed my mind during a few particularly painful toe sessions. Diet, exercise, and keeping hydrated do a lot to keep it under control, but nothing beats allopurinol.

Tophi ain’t a gout attacks (as you state, but contrary to what you implied earlier).
I’ve got tophus in my elbow, but I’ve never had a gout attack there.

I have pseudogout - same pain, different chemical making it. I agree, I have thought about amputation, but I always figure I’d be one of the ones that gets phantom pain. Hard to cure phantom pain :frowning: If I leave the feet on my body, I can at least choke down painkillers, take the colchicine until the mouth sores form and hope the flare goes away soon. I’d kill for allopurinol or something I could take to prevent flares.

'Nother gouter here.

A word to any of you that are fishermen…

Early in the season one year, I stood in cool/cold water for a couple of hours while fishing. Fishing was good, so I was there for a while.

Oooh, baby, did the ol’ gout love that. It got good and imbedded. It took a couple of days worth of indomethacin to erase that one.

I’ve only had one other ‘double-footer.’ I think cashews were to blame for that one.

Hmmmm. Try febuxostat? It’s supposed to be the latest and greatest in gout medicine, especially for those who respond badly to allopurinol. I’m not really looking to switch, since allopurinol works well for me, is cheap, and kept my dad’s toes calm for over 35 years on it. But I’d love to hear about it from a user, especially someone who switched from allopurinol.

Preach it, sister. During my first really serious attack years ago, I had to steel myself up a good 10 minutes before I put my “gout shoes” on so I could go to the doctor.

I am 28 years old and have had gout for 5 years in my both ankles , knee and elbow , my Uric acid level is above 600 when should only be below 300 in my condition I become bed bound and cannot walk at all in extreme pain and in and out of hospital.
I have been taking 300 ml alpurinol and u am now getting my dose up to 600 ml as the alpurinol is not having affect as it is such low dosage for my Uric acid level
However acorxia and colchine help with acute attacks, I am now on steroids called depo-medrone which is used for
Rheumatoid arthritis.
Inflammatory disease called systemic lupus erythematosus, which can affect many organs throughout the body and is caused by the immune system attacking connective tissue in the body.
Severe allergic skin reaction called erythema multiforme (Stevens-Johnson syndrome).
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If anyone is suffering with gout and seems like the pain is not going away ask for this steroid to help I had my first injection today after being in pain for a solid 3 months and I can feel the difference already it’s 4hrs for full affect .

Good luck with the gout situation nasty thing to have its wrecked my life