Viewer Question:

Is it possible to have an attack of gout starting at your baby toe?  A painful, burning feeling, which then goes to the other side of the foot?  Then, in a couple of days, the same thing happens to the other foot!
Signed, EK

Doctor's Response:

Yes.  The fact is, there is no single pattern for the attacks of joint inflammation (arthritis) from gout.  By far, the most common location for gouty arthritis is inflammation of the joint at the base of the great toe (first metatarsal phalangeal joint).  It is also common for gout to attack the small joints in the toes and then seem to spread to cause inflammation of the foot. Gout affecting both feet simultaneously does occur, but is less frequent than attacks affecting a single side of the body.

I am a rheumatologist who has been in practice for many years.  As a result, I have seen many common and uncommon presentations of gout.  Among the common are gout attacks of arthritis at the base of the great toe, arch of the foot, ankle, and knee.  I have also seen uncommon gouty arthritis involving different fingers, the thumbs, wrists, and elbows.  I have even personally found gout crystals deposited in the tissue covering the eye (conjunctiva)!  Gout crystals have been reported in the spine, but this is exceedingly rare.

It should be kept in mind that other types of inflammatory arthritis can cause inflammation in the toes and feet.  Among these are rheumatoid arthritis, reactive arthritis, and psoriatic arthritis.

Thank you for your question.

Medical Author William Shiel, MD, FACP, FACR
Medical Editor: Leslie J. Schoenfield, M.D., Ph.D.

Last Editorial Review: 12/30/2004

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