Gout is a systemic condition caused by elevated levels of uric acid in the serum. This can be secondary to either overproduction or under secretion of uric acid by the patient’s body. Gout can either be primary or it can be secondary to conditions that result in rapid cell turnover such as malignancies or due to inability to eliminate uric acid secondary to impaired renal function. Gout can present with intense and dramatic joint flares as well as destructive arthritis caused by the body’s inflammatory response to uric acid crystal deposits in joints.
Gout in the feet
The most common joint in the body in which gout occurs is the first metatarsal phalangeal joint in the foot and the second most common joint is the ankle joint. Uncontrolled elevated serum uric acid can also result in kidney stones and can cause injuries to the kidneys or urinary tract. Another manifestation of gout is the extra-articular deposit of sodium urate crystals in soft tissues which is known as tophaceous gout. These deposits will increase gradually in size and ultimately can ulcerate. They are poorly responsive to surgical intervention unless the underlying systemic condition is treated. Once the uric acid levels in the serum are controlled, the sodium urate crystals will be resorbed and, ultimately, eliminated in the urine.
Gout medical expert witness specialties include internal medicine, podiatry, radiology, nephrology, rheumatology, orthopaedic surgery, and foot and ankle orthopaedic surgery.