What Is Ankle Gout?

Sudden pain in your ankle may be a condition known as gout, but there are several ways to manage symptoms and prevent it.

Senior woman sitting on a yoga mat, grabbing an ankle
Photo: Getty Images

Gout is a type of inflammatory arthritis, a condition in which the immune system has a strong reaction, attacks otherwise healthy joints, and leads to inflammation.¹ When gout symptoms like intense pain and swelling develop, it's known as a gout flare. These flares can last from days to weeks and usually affect one joint at a time. When a gout flare affects the ankle, it is known as ankle gout.²

What Causes Gout in the Ankle?

The underlying cause of gout in the ankle is the same as gout in other joints. Gout occurs when excess uric acid, a waste product of your metabolic process, builds up at a joint and triggers inflammation.²

During metabolism, your body produces uric acid after breaking down organic compounds called purines. Purines are found in the body and in purine-rich foods, like red meat and some seafood. Usually, the body transports uric acid from the bloodstream to the kidneys, discarding it in urine.³

But at times, hyperuricemia can occur. This is a condition when there is too much uric acid in the bloodstream—either from a high-purine diet or because the kidneys aren't removing the acid properly. Not all cases of hyperuricemia lead to gout, but some people with hyperuricemia can develop gout when uric acid crystals build up at specific sites in the body.²,³

Gout in the ankle occurs when uric acid crystals become lodged in the ankle. This leads to swelling; redness; and sudden, intense pain

Besides the ankle, gout can also affect other joints, the kidneys, and around tendons.⁴ The most common site of a gout attack, though, is in the big toe.²

Most gout attacks peak about 12 to 24 hours after they begin. Then, symptoms usually slowly get better in one to two weeks, with or without treatment.³

Some people may only have one gout flare in their life. But other people may experience a gout flare in the same joint multiple times. This is known as a recurring flare.³

Between recurring flares are periods of remission, when there are no symptoms for weeks, months, or even years before the next flare.² People with recurring gout flares can experience more severe symptoms for longer periods, such as damage in the joint, and develop gout in other places in the body.⁵

Are You at Risk?

Men are three times more likely to experience gout than women. This is because estrogen, a female sex hormone, is protective against developing high levels of uric acid in the bloodstream.³

The risk of gout also increases with age. Men older than age 40 or women who have gone through menopause—when estrogen has declined—are more likely to develop gout.³

Other risk factors for gout include:

  • Obesity or being overweight. The body may produce more uric acid and have more difficulty discarding it.³
  • Having chronic health conditions. This includes heart disease, high blood pressure, metabolic syndrome, diabetes, and poor kidney function.²,³
  • Taking diuretics. Also known as water pills, these are intended to help the body discard more fluids but can also increase gout risk.⁴
  • High consumption of added sugars. These sugars can be found in foods and drinks like those with high-fructose corn syrup.³,⁶
  • Eating a diet high in purines. This includes food like red meat; organ meat; or seafood like anchovies, sardines, mussels, scallops, trout, and tuna.²
  • Drinking alcohol. Excessive amounts of alcohol can reduce kidney function, and some drinks, particularly beer, are also rich in purines.⁶
  • Having a family history of gout. This may predispose an individual to develop gout.³

Symptoms of Ankle Gout

Gout in the ankle can sometimes be difficult to identify. It's easy to confuse it with an ankle sprain or strain. But unlike ankle injuries, gout in the ankle occurs without a prior wound. It also comes on quickly. The main symptoms of ankle gout include:²

  • Intense pain
  • Redness
  • Swelling
  • Heat

Diagnosing Gout in the Ankle Joints

Visit a healthcare provider if you suspect that you have gout in the ankle. A primary healthcare provider will likely refer you to a rheumatologist—a doctor who specializes in inflammatory diseases—for diagnosis and treatment.²

A provider may use the following tools when diagnosing gout in the ankle:³,⁷

  • Physical exam: To examine the ankle joint and rule out other possible causes of the pain and swelling
  • Medical history: To learn about your family history and health risk factors associated with gout
  • Blood test: To detect elevated levels of uric acid in the blood
  • Joint fluid analysis: To check the joint fluid for uric acid crystals
  • Ultrasound, X-rays, or other imaging tests: To look for uric acid buildup in the joint

What Treatment Is There?

With early intervention and treatment, gout is one of the most manageable types of arthritis.⁴ Once a diagnosis has been made, a primary care provider can likely help manage your condition.²

Although there is no cure for gout, treatment options are available to help reduce symptoms.² Managing a flare involves reducing pain and swelling. Depending on your symptoms and existing health conditions, your provider may recommend some of these common treatments for a sudden gout flare:³,⁷

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen
  • Corticosteroids, which are anti-inflammatory steroids
  • Colchicine, an anti-inflammatory prescription drug
  • Ice
  • Elevation
  • Rest

Gout symptoms usually subside and resolve on their own after a few days to weeks, though treatments can help with discomfort.³

Some people may have recurring gout flares and, if left untreated, can develop tophi, late-stage, severe gout that appears as lumps under the skin and that can permanently damage the joint.³,⁵

If you experience frequent, recurring gout flares, your provider may prescribe medication that reduces uric acid buildup in the body in hopes of preventing future flares.³

You Can Prevent Ankle Gout

Making lifestyle changes that reduce excess fat and high levels of purine in the body can reduce the risk of gout. This can include exercising regularly, maintaining goal weight, and limiting alcohol intake and purine-rich foods.²

Following specific diets might also lower your risk of gout. One study of more than 44,000 men estimates that following a DASH diet could prevent up to 22% of gout incidents.⁸ Originally developed for the management of high blood pressure, DASH stands for Dietary Approaches to Stop Hypertension. This diet consists of vegetables, fruits, whole grains, lean protein, low-fat dairy, nuts, and beans. DASH also limits red meat, fatty meat, and sugar-sweetened foods and beverages.⁹

And while more research is needed on its impact on gout risk itself, the Mediterranean diet has been shown to lower the risk of high levels of uric acid. This diet is rich in fruits, vegetables, whole grains, and legumes. It limits red meat and sugar-sweetened foods and beverages.¹⁰

Some studies also suggest that low-fat dairy products, coffee, and vitamin C are specifically each associated with a lower risk of gout, likely because they may help the kidneys discard uric acid from the body.⁶

Before you make any changes to your lifestyle or diet, talk with your healthcare provider about developing an individual prevention plan.

Summary

If you suspect that you may be experiencing gout in the ankle, see a healthcare provider. While a flare usually resolves on its own, there may be medications that can help reduce the pain and swelling.

While there is no cure for gout, it can be successfully managed.² To lower your risk of ankle gout —or any other gout attack—focus on healthy lifestyle changes. Meeting with a healthcare provider or a dietician may be helpful for addressing gout over the long term.

Sources

  1. Arthritis Foundation. What is arthritis?
  2. Centers for Disease Control and Prevention. Gout.
  3. Arthritis Foundation. Understanding gout.
  4. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Gout symptoms, causes & diet recommendations.
  5. National Kidney Foundation. Gout and kidney disease.
  6. Roddy E, Choi HK. Epidemiology of gout. Rheum Dis Clin North Am. 2014;40(2):155-175. doi:10.1016/j.rdc.2014.01.001
  7. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Gout: Diagnosis, treatment, and steps to take.
  8. McCormick N, Rai SK, Lu N, Yokose C, Curhan GC, Choi HK. Estimation of primary prevention of gout in men through modification of obesity and other key lifestyle
  9. National Heart, Lung, and Blood Institute. DASH eating plan.
  10. Guasch-Ferré M, Bulló M, Babio Nancy, et al. Mediterranean Diet and Risk of Hyperuricemia in Elderly Participants at High Cardiovascular Risk. J Gerontol A Biol Sci Med Sci. 2013;68(10):1263–1270. doi:10.1093/gerona/glt028
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