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Dr. Andrew Rynne

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Suggest treatment for swollen foot while treating gout

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Dr. Aashish Raghu

Orthopaedic Surgeon

Practicing since :2011

Answered : 5172 Questions

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Posted on Thu, 23 Mar 2017 in Lump
Question: My husband age 69 is having a gout attack. Previously the symptoms went away after a couple of days, and he took and is still taking indomethacin. Today the great toe area and much of the foot is swollen and he is using a cane. It is Sunday. Our urgent care is closed. Should he go to the ER - what can they do for him- or wait to call his MD tomorrow.
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Answered by Dr. Aashish Raghu 28 minutes later
Brief Answer:
Medication, Fomentation, Steroid

Detailed Answer:
Hi there

Thanks for the query

It is advisable to take Tablet Ibuprofen 400mg twice a day after meals and Tablet Rabeprazole twice a day before meals for 5 days.

Apply ice to the affected region. Avoid weight bearing on the affected limb.

An oral steroid such as Tablet Deflazacort 6mg twice a day for 3 days, then tapered to 6mg once a day for 3 days, then tapered again to 3mg twice a day for 3 days, followed by 3mg once a day for 3 days.

This will have better Antiinflammatory action and provide great relief.

Also keep the foot submerged in XXXXXXX warm water with added table salt or Epsom salt will reduce the oedema and pain.

Also let him keep well hydrated because dehydration can precipitate a Gouty attack.

If medication and icing the toe do not help, it is best he visit the ED.

I hope I have answered your query.

I will be available to answer your follow up queries.

Regards,

Dr. Aashish Raghu
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Aashish Raghu 13 hours later
Dear Dr. XXXXXXX

Thank you for the thorough answer. We iced the foot and toe- now the pain is mostly in the heel, though the foot has edema- this seems to help relieve some of the discomfort. Also he took the ibuprofen.

I had not thought about steroids but that is an excellent suggestion. We could not see his doctor today as it is Sunday, will definitely now know what he can order to help.

One other concern. My husband started Aspirin 81 mg. daily last Monday because he had some possible neurological symptoms indicating mini-stroke, but not confirmed yet. The gout symptoms started on Thursday. (Tomorrow is a brain CT). Anyway, we read that aspirin possibly could exacerbate symptoms of gout so we will mention this to the doctor tomorrow. We wonder if that had anything to do with the current symptoms which are worse than in previous gout attacks. This is a small dose of aspirin though.

Again, thank you for your assistance.
doctor
Answered by Dr. Aashish Raghu 9 hours later
Brief Answer:
Yes. Low dose Aspirin causes Gout attacks.

Detailed Answer:
Low dose Aspirin is known to prevent the excretion of dangerous uric acid crystals, such then accumulate in the joints.

Low dose Aspirin if 81mg/day has twice the risk of causing Gout attack if taken for even 2 days.

I suggest he takes Tablet Allopurinol 100mg/day to reduce the Uric acid level long term. This shall counter the effects of Aspirin.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Aashish Raghu 3 days later
Dear Dr. XXXXXXX

Looks like you are indeed right. My husband got somewhat better, did epsom salt soaks and other things you suggested. Then he went to his doctor who did not feel aspirin at the 81 mg. dose would have an effect. So husband took one more dose and indeed, big flareup the next day. Big mistake. Now no aspirin for two days, better, walking around etc. Now he also has prescription for Allopurinol 100 mg. which he is advised to start after the gout attack is over. Thanks again!

ps to my last note. Yes I recognize that it is possible to take low dose aspirin at the same time as Allopurinol. We will continue to evaluate the need for aspirin but not rule it out for use entirely. All tests for stroke possibility have been negative, fortunately.
doctor
Answered by Dr. Aashish Raghu 10 hours later
Brief Answer:
Follow up

Detailed Answer:
Thanks for the reply.

Hope he gets well soon.

Good Luck.
Above answer was peer-reviewed by : Dr. Yogesh D
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