Not Just the Big Toe: The Most Common Places Gout Harms

by Malaika Hill Health Writer

When uric acid accumulates in your body, it can form needle-like crystals in your joints or the surrounding connective tissue and cause a painful attack of gout. While it’s typically joints such as the big toe that suddenly swell and become the source of gout’s trademark stabbing pain, this form of arthritis can cause long-term damage to other areas of the body if not treated early — many of which don’t involve your joints at all.

Foot of a gout patient.

Most common gout attack sites

The most common site for a gout attack is what is known as the bunion joint on the big toe. It is typically the first joint affected by gout. As gout worsens, the ankle, mid-foot, knee, and elbow can become common sites of gout attacks. Uric acid crystals can also collect in soft tissues and form lumps called tophi, most typically on the hands, fingers, elbows, and ears.

Fingers of a gout patient.

Least common gout attack sites

If gout is left untreated and becomes chronic, its lingering inflammation can attack other, less common sites on the body, including the fingers, wrists, and — very rarely — the shoulder and hip. There have also been cases of uric acid crystal deposits detected in eye tissue and on spinal cord tissue, which is known as spinal gout. Spinal gout typically shows up in the form of back or neck pain.

Gout patient with inflamed joints.

What does a gout attack look and feel like?

Symptoms of a gout attack on joints are similar no matter which joint is affected. When gout flares up, you will experience extreme pain and stiffness in the affected joints and the area will also be red and warm to the touch. Inflammation from the gout attack can also affect your entire body in the form of a fever, chills, fatigue, and achiness.

Tophi on the foot of a gout patient.

Let’s talk more about tophi

Sometimes, after repeated severe gout attacks, uric acid crystals collect beneath the skin and form small white or yellow lumps called tophi. They are typically found in soft tissue around the affected joints; on the elbow; or on the exterior part of the ear. Fortunately, tophi can be dissolved with treatment. When left untreated, they can gradually destruct bones and cartilage, leading to discomfort and immobility.

Doctor holding kidneys.

Gout and your kidneys

An overabundance of uric acid can lead to both kidney problems and gout. Uric acid that collects in the kidneys can form kidney stones, which can lead to complications like kidney disease and kidney failure, and also can indicate a likelihood of developing gout. If you’ve been diagnosed with gout, your uric acid levels are elevated and you should also be checked for kidney disease.

Doctor with stethoscope and red heart shape with icon heartbeat in hands.

Gout and your heart

If you have gout, chances are high you also have high blood pressure, coronary artery disease, or heart failure. Although gout does not attack the heart directly, the buildup of uric acid crystals induces inflammation, which can lead to blood clots that can lead to a heart attack or stroke over time. In fact, research shows that gout doubles a person’s risk for having a heart attack or stroke.

Senior man getting an eye exam from an optometrist.

Gout and your vision health

Over time, the uric acid crystals and inflammation associated with gout can lead to vision complications. They can include tophi in the eyelids, cornea, and iris; dry eye syndrome; uveitis; glaucoma; and cataracts, which cloud the lens of the eye and impair vision.

Doctor performing a test on a urine sample.

Does the location of the gout attack affect treatment?

No matter the location of gout attacks, the treatment is the same—lower uric acid levels so gout crystals disappear and tophi dissolve. Your doctor can test your urine and blood to determine your current levels. Normal uric acid levels typically range between 3.5 and 7.2 mg in men and between 2.6 and 6.0 mg in premenopausal women.

Woman shopping for supplements.

How to prevent complications and future flares

Uric acid levels can be lowered in a number of ways. Your doctor may prescribe medication that reduces the intensity and duration of a gout attack and also breaks down the buildup of uric acid crystals. There are supplements that lower uric acid levels. And, these lifestyle changes also can help keep uric acid in check: avoid alcoholic beverages, stick to a healthy diet that limits foods high in purines, keep hydrated, and maintain a healthy weight.

Malaika Hill
Meet Our Writer
Malaika Hill

Malaika Hill is a freelance health writer specializing in ophthalmology and population health. For the past decade, she has dedicated her work to helping eye care professionals communicate advances in ophthalmic research to their peers and patients in an effort to provide the highest-quality eye care. She serves on the editorial board of the Interdisciplinary Association for Population Health Science where she is committed to exploring and communicating short- and long-term strategies to prioritize eye and vision health disparities across the world. Malaika can be found on her website, LinkedIn @malaikadavid, or Twitter @malaika_hill.