Etiology Gout is a metabolic disease caused by abnormal purine metabolism resulting in increased uric acid synthesis. Plasma is saturated with uric acid, resulting in the deposition of monosodium urate crystals in the relatively unvascularized tissue surrounding distal joints. The presence of these crystals can lead to acute inflammatory synovitis in single or multiple joints. Involvement of the first metatarsophalangeal joint occurs in 90% of patients with gout at some point in their lives. Other areas of the foot that may be involved are the back of the foot, the heel, and the ankle. In addition to involving the joints, uric acid crystals can be deposited under the skin in what are called gouty nodules. Clinical presentation Acute gout attacks are characterized by severe pain, swelling, erythema, stiffness, and fever in the affected joints, and occur suddenly. The attack usually lasts from a few days to a week. The onset of the attack is usually unprovoked, but can be secondary to mild trauma or the consumption of purine-rich foods. Diagnosis is also generally based on a history of symptoms, the characteristic site of the first metatarsophalangeal joint, and the often polyarticular nature of the disease, combined with an elevated blood uric acid level. If a definitive diagnosis cannot be made, or if the clinical presentation is monoarticular involvement of the knee, ankle or wrist, an arthrocentesis should be performed to rule out infection. Gout occasionally has a chronic onset and presents as an enlarged protrusion of the first metatarsophalangeal joint due to osteophytes and gout crystalline deposits. During the initial attack of gout, the imaging changes in the bone and joint surfaces are not significant, but as the disease progresses, the periarticular destruction may appear as classic bilateral “rat bite” damage to the joints. The joint surfaces are not usually involved, but in chronic cases the joints may be severely damaged. Treatment Acute attacks of gout should be treated with rest, elevation of the affected limb, hard-soled shoes, and open-toed postoperative shoes to relieve symptoms. Medication includes high-dose NSAIDs or colchicine. When chronic gout nodules are present, debridement or deposit removal may be performed on symptomatic areas. Prevention Reduce the intake of purine-rich foods, such as animal offal, seafood, poultry and beans, and drink more water to promote the excretion of uric acid from the body. Control of diet is the first, but do not over-understand; gouty arthritis in the acute stage, medication is needed; after paying attention to diet, regular blood uric acid checks, if not high, no medication is needed; if high to a certain standard, medication is needed (this condition is not part of orthopedic consultation).