Is pain in the instep without swelling gout?

Some older people often suffer from gout, which is mainly a joint disease. It is mainly caused by the damage to the joints due to people's failure to pay attention to protecting their bodies when they are young. There are many joints on the backs of people's hands and feet. Some people find that their insteps are not hit by external force and are not swollen, but they are painful. Could this phenomenon be caused by gout?

First issue

In this period, patients with asymptomatic hyperuricemia will have increased uric acid concentration in their serum, but will not have clinical symptoms of arthritis, tophi, or uric acid stones. Some male patients will experience this during puberty, which may be related to family history, while female patients will more often experience it during menopause. Asymptomatic hyperuricemia may persist throughout life.

It will exist, but it may also develop into acute gouty arthritis or kidney stones. Clinically, most asymptomatic hyperuricemia patients will first develop gout symptoms and then develop other conditions, but please note that about 10% to 40% of patients will first develop kidney stone symptoms.

Second issue

Patients with acute gouty arthritis will experience severe pain in the affected joints during this period. In the early stages of the disease, it often affects a single joint (accounting for 90%), of which about half occur in the metatarsal joints of the foot. As a result, patients are in unbearable pain and cannot wear shoes, so they often come to the clinic wearing slippers. However, as the disease progresses, it is likely to affect multiple joints, and sometimes it may only affect other parts. Common gout sites include the big toe, instep, ankle, heel, knee, wrist, fingers and elbow, but other parts may also be affected. The key point of diagnosis should be to maintain a high degree of vigilance and never assume that pain in other parts of the body is definitely not caused by gout.

Generally speaking, gout patients will begin to experience severe pain and joint inflammation at night, sometimes with fever. This condition often occurs after overeating, especially after a banquet, drinking, taking drugs, trauma or surgery, and sometimes after an ankle sprain, especially when dehydrated. Clinically, there may be no abnormality before the patient goes to bed, but the severe pain caused by a gout attack may wake the patient up from his sleep, and the affected joints will experience severe redness, swelling, heat and pain, which is extremely painful. The symptoms will gradually become more severe, and the chills and tremors will also increase. The most painful moment is like tearing, which is unbearable, and then the symptoms will slowly subside.

Due to local redness, swelling, heat and pain, often accompanied by fever, some patients may also have swollen joints and fluid accumulation, and yellow turbid fluid will appear when the fluid is extracted. Therefore, it is sometimes mistaken for cellulitis or bacterial arthritis and treated with antibiotics. This may last for one or two days or up to two weeks, and then gradually improve.

Third issue

The interictal period of gout refers to the period when the patient's symptoms disappear, that is, the patient does not show any symptoms clinically; the interictal period varies in length and may last from one or two days to several weeks. About 7% of patients are lucky and their gout will subside naturally without symptoms, but most patients will relapse within a year. After repeated attacks, the disease tends to be polyarticular, the attacks are more severe, the duration of the attacks is longer, and they are accompanied by fever. But some people will never have an attack again.

Fourth issue

Tophi and chronic gouty arthritis Patients with tophi and chronic gouty arthritis have a more chronic condition. Uric acid crystals will be deposited in the cartilage, synovial membrane, and soft tissue in the body, forming tophi. The higher the uric acid concentration in the blood and the longer the disease lasts, the more tophi may be deposited, sometimes affecting blood vessels and kidneys, causing serious renal dysfunction.

Failure makes kidney disease more serious and creates a vicious cycle of difficulty in excreting uric acid, resulting in more tophi deposits.

There are many places where tophi are often deposited, including the ears, hands, elbows, Achilles tendons, ankles or toes. Sometimes they can cause local ulcers that are difficult to heal and may even require surgical removal. Severe cases may cause joint deformities or chronic symptoms. Severe foot deformities may cause serious problems for patients in wearing shoes. In addition, the risk of kidney stones increases with the increase of uric acid concentration in serum, and it often causes kidney disease. After renal failure, hemodialysis may be required, which is also one of the main causes of death in gout patients.

In addition, gout is common in patients with obesity, hypertriglyceridemia and hypertension. In obese people, uric acid production increases and excretion decreases, causing hyperuricemia and gout. If these diseases occur simultaneously in clinical practice, it may also cause a situation that is difficult to control, so attention should be paid to evaluating them simultaneously during the examination.