Q: My dad has a gout problem. About seven years ago, he started having swollen feet. At first, the swelling subsides after he takes medication or gets an injection.
However, as time goes by, the swelling does not go away after treatment. Both his feet currently have swollen areas.
On his left foot, the swollen part is near the big toe, making it difficult for him to find a pair of sandals that will fit.
Around five years ago, he was advised to go for an operation to remove the liquid inside.
An orthopaedic surgeon told us that my father has a condition called gouty tophi and requires surgery.
However, after the operation, the swelling on his left foot seems to have returned and spread over a bigger area.
On top of that, his right foot has also has become swollen, on the side of the foot.
I am not sure if surgery is the best option. A doctor mentioned the swelling has got to do with his diet as well.
What I should do about my father's condition?
A: Gout occurs when there is excessive uric acid in the blood.
It is normal for the body to make uric acid after eating certain foods. Most of this acid passes out of the body through the urine. However, certain foods, medication and medical conditions can cause uric acid to build up in the body.
When this occurs, the uric acid turns into crystals which can accumulate in the joints, causing the pain and swelling associated with a gout attack.
A gout attack usually lasts for five to 10 days and can affect any joint, though it most commonly affects the big toe or another part of the foot.
The crystals under the skin cause lumps which are called tophi.
Tophi can grow on the elbow, hands or feet. It can occasionally be painful and cause skin ulcers (open sores).
In some locations, such as the feet, these can cause difficulties with walking and wearing shoes.
It will be advisable for your father to be reviewed by a doctor for treatment of his gout.
This may involve taking medication to lower the uric acid levels in the blood, particularly if he has frequent gout attacks.
A variety of medication are available to suit different patients, based on their other medical conditions.
Such "preventative medication" is taken on a daily basis.
The doctor may also prescribe medicine to relieve the pain of a gout attack.
Regular blood tests are required to monitor one's level of uric acid.
Lowering uric acid levels will make the gouty tophi smaller and prevent recurrent gout attacks, joint inflammation and joint damage.
Surgery for tophi is occasionally required if there are complications, such as infections or nerve compression.
Otherwise, medication will be initiated together with dietary advice and a review of the patient's potential precipitants for gout.
Appropriate footwear is important for people whose gout affects their feet.
Choose comfortable shoes with a wide toe box and a firm, cushioned insole to support the feet.
DR POH YIH JIA, associate consultant at the department of rheumatology and immunology at Singapore General Hospital
This article was first published on January 22, 2015.
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