Signs of the Next Attack and Why the Big Toe Is Commonly Affected

Symptoms of the Next Attack

At least 50 percent of gout sufferers will have a second attack. The next attack may not occur for months or even years. However, over time, gout attacks can last longer, occur more frequently, and be more destructive to joints and other tissue unless the problem is treated.
Over time, uric acid crystals can accumulate in the body, causing gritty, chalky deposits called tophi that are sometimes visible under the skin, particularly around joints and in the edges of the ears. Tophi may also form inside bone near the joints, in the kidneys, and in other organs and tissues, causing permanent damage. Fortunately, advances in gout treatment have made this kind of chronic gout extremely rare.

The Big Toe and Gout Symptoms

Why is the big toe the most common site for initial symptoms? There are perhaps two reasons for this. First, the extremities are a bit cooler than other parts of the body, and uric acid crystals form more readily at lower temperatures. Second, normal walking and standing subject the feet to considerable stress. Together, these factors might explain why the big toe, heel, instep, and Achilles tendon are among the places where symptoms occur.
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