# Gout > Gout is a painful type of arthritis caused by urate crystals building up in a joint, most often the big toe. Flares come on suddenly and usually settle within a week or two. Medicines from a doctor treat flares and can help prevent them coming back. Guide in [Arthritis and gout](https://footanklelowerlimb.com.au/learn/topics/arthritis-and-gout), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/gout Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 27 October 2026. Next review by 27 October 2027. - **Gout is joint inflammation caused by crystals,** most often in the big toe, and isn't a sign of poor hygiene or lifestyle failings alone. - **Flares come on fast** with severe pain, swelling, redness and warmth, and usually settle in a week or two. - **Medicines are the main treatment,** and starting early in a flare matters. - **Long-term treatment can help prevent flares,** and is set up with your doctor. - **A hot, swollen joint with a fever and feeling very unwell could be an infection, not gout,** so go to the nearest emergency department. ## What is gout, and how common is it? Gout (also called gouty arthritis) is a type of arthritis caused by urate crystals building up in a joint [1]. When there's too much urate (also called uric acid) in the body, crystals can form in the joints and lead to inflammation and damage [2]. It's the most common inflammatory arthritis [3]. A flare brings sudden, severe pain, swelling, redness and warmth. The big toe is the joint most often affected, but gout can affect any joint [1][3]. Reported rates range from about 0.9% to 5.1% of people, depending on the country [4][5]. It's more common in men and in older people [6]. ## What causes gout, and who gets it? Gout starts with high urate in the blood. Crystals can form slowly over months or years, usually without symptoms, and then trigger a sudden flare [1]. Many people with high urate never get gout [7]. Your risk is higher if you're older or male [6], have a family history of gout, drink alcohol or sugar-sweetened drinks, or eat a diet rich in purines (usually from animal sources) [7]. Some medicines, including diuretics (fluid tablets) and low-dose aspirin, can raise the risk [7]. Please don't stop a prescribed medicine on your own; talk with whoever prescribes it. Gout also goes along with heart disease, kidney disease and diabetes [8]. These are links, not proof that one causes the other. Genes also play a strong part [3], so diet alone is rarely the whole explanation. ## What does gout feel like, and how is it diagnosed? A flare usually comes on quickly, often at night, with severe pain, swelling, warmth and redness over a joint that's very sore to touch [1][2]. It's usually one joint at a time, often the big toe, but it can be another toe, the ankle or the knee [9]. Pain tends to peak within 24 hours and settle in 1–2 weeks [2]. Redness may be harder to see on black or brown skin [10]. A definite diagnosis comes from finding urate crystals in fluid taken from the joint. Guidelines recommend looking for them whenever gout is suspected [11]. A blood urate test on its own isn't enough: it can be normal during a flare, and a high result doesn't prove gout [6][11]. If crystals can't be found, imaging such as ultrasound can help [11]. A podiatrist or GP can refer you to a doctor for testing. ## What helps a gout flare first? A doctor's prescribed medicines are the main treatment for a flare. Guidelines recommend colchicine (a gout medicine), anti-inflammatory medicines (NSAIDs) or corticosteroids (steroid medicines), or a combination [12]. Treatment is usually continued for a few days, typically 3–5 days [13]. Starting early matters: guidelines advise treating a flare as early as possible, preferably within 12 hours of the first warning signs [13]. It can help to agree a flare plan with your doctor ahead of time. Which medicine suits you depends on your other health conditions and how you've responded before [13]. Colchicine can cause diarrhoea and headache [14]. Anti-inflammatories can upset the stomach and possibly affect the heart [6], and are best avoided with kidney problems [13]. Check with your doctor or a pharmacist first if you've had ulcers or heart or kidney disease. ## What helps if that isn't enough? If flares keep coming despite treatment, or your medicines cause side effects, go back to your doctor for a medicine review. It's also reasonable to ask about seeing a rheumatologist (a doctor who treats arthritis). Antibody medicines that block an inflammation signal are generally recommended for flares when other drugs have caused side effects or haven't worked [2]. These are started by a doctor. > [!tip] Try this > Keep a simple record of your flare dates, the joints affected and the treatments you've tried. It gives your doctor a clear picture at your next review. ## How long does gout last, and can I stop it coming back? Each flare usually gets better within a week or two, and you often have no symptoms in between [9]. Left untreated, flares may come more often and last longer, and tophi (hard urate lumps under the skin) can develop over time [9]. For long-term control, guidelines advise considering urate-lowering medicine from your first presentation, alongside education and non-drug steps [12]. Your doctor prescribes it, adjusts it to your kidney function and monitors it [12]. Keep taking it as directed, and talk with your doctor before changing it. Weight loss is recommended if your BMI is above 25 kg/m2 [13]. Alcohol and sugary drinks are linked with gout, so cutting back may help [7]. Because gout goes with heart and kidney conditions, guidelines recommend checking your blood pressure, kidneys and cardiovascular risk [11]. ## When to see a podiatrist See your GP or a podiatrist the same day if a joint suddenly becomes very painful, hot, red and swollen, or the pain doesn't ease with pain relief [1]. A hot, swollen joint shouldn't be assumed to be gout, because gout and joint infection can occur together [15][16]. For urgent advice when it isn't an emergency, call healthdirect on 1800 022 222 (24 hours a day), or go to a Medicare Urgent Care Clinic. Go to the nearest emergency department if a joint is suddenly hot, swollen and very painful, and you also have a fever and feel very unwell. See your GP if flares keep coming back, or your medicines are causing side effects. ## Common questions ### Is gout caused by eating the wrong foods? Not by food alone. Alcohol, sugary drinks and purine-rich foods can raise your risk, but genes, body weight, kidney function and some medicines matter too. Many people with high urate never get gout. Cutting back on trigger foods and drinks can help, but gout isn't your fault, and diet alone rarely explains it. ### Can you have gout with normal uric acid levels? Yes. Urate in the blood can look normal during a flare, so a normal result doesn't rule gout out, and a high result doesn't prove it. Finding urate crystals in fluid from the joint is the most reliable way to confirm it, so ask your doctor about testing. ### Do I need to take allopurinol for life? It isn't clear yet how often urate-lowering medicine such as allopurinol can safely be stopped. Many people stay on it long term to keep urate down and prevent flares. Please don't stop it on your own; talk with your doctor, who can review whether it still suits you. ### Can women get gout? Yes. Gout is more common in men, but women can get it too, particularly as they get older. The symptoms are the same: a sudden, painful, swollen, warm joint, often the big toe. If a joint flares suddenly, see your GP rather than assuming it can't be gout. ## Further reading - [Gout on Clindice](https://clindice.com/gout) - [What Is Gout?](https://my.clevelandclinic.org/health/diseases/4755-gout), Cleveland Clinic - [Gout](https://www.nhs.uk/conditions/gout/), NHS - [Pain in your big toe - gout - Bradford District Care NHS Foundation Trust](https://www.bdct.nhs.uk/pain-in-your-big-toe-gout/), NHS ## Sources 1. Gout – symptoms, causes and treatment · Healthdirect Australia. https://www.healthdirect.gov.au/conditions/joint-and-muscle-diseases/gout 2. Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) common language definition of gout · Murdoch R, Barry MJ, Choi HK et al. · RMD Open · 2021. https://doi.org/10.1136/rmdopen-2021-001623 3. Global, regional, and national burden of gout, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021 · The Lancet Rheumatology · 2024. https://doi.org/10.1016/s2665-9913(24)00117-6 4. 2015 Gout Classification Criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative · Neogi T, Jansen TLTA, Dalbeth N et al. · Arthritis & Rheumatology (Hoboken, N.J.) · 2015. https://doi.org/10.1002/art.39254 5. Gout · FitzGerald JD · Annals of Internal Medicine · 2025. https://doi.org/10.7326/annals-24-03951 6. Gout · Underwood M · BMJ Clinical Evidence · 2011. https://pmc.ncbi.nlm.nih.gov/articles/PMC3275296/ 7. Gout · National Institute of Arthritis and Musculoskeletal and Skin Diseases · 2017. https://www.niams.nih.gov/health-topics/gout 8. Management of gout and hyperuricemia: Multidisciplinary consensus in Taiwan · Yu KH, Chen DY, Chen JH et al. · International Journal of Rheumatic Diseases · 2018. https://doi.org/10.1111/1756-185x.13266 9. Gout · National Institutes of Health · 2024. https://www.nlm.nih.gov/medlineplus/gout.html 10. Gout · NHS · 2026. https://www.nhs.uk/conditions/gout/ 11. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout · Richette P, Doherty M, Pascual E et al. · Annals of the Rheumatic Diseases · 2020. https://doi.org/10.1136/annrheumdis-2019-215315 12. 2016 updated EULAR evidence-based recommendations for the management of gout · Richette P, Doherty M, Pascual E et al. · Annals of the Rheumatic Diseases · 2017. https://doi.org/10.1136/annrheumdis-2016-209707 13. The Hong Kong Society of Rheumatology consensus recommendations for the management of gout · Yip RML, Cheung TT, So H et al. · Clinical Rheumatology · 2023. https://doi.org/10.1007/s10067-023-06578-9 14. Korean guidelines for the management of gout · Lee JJ, Lee JS, Chung MK et al. · The Korean Journal of Internal Medicine · 2023. https://doi.org/10.3904/kjim.2023.206 15. Concomitant septic and crystal arthropathy: a single-centre 10-year retrospective observational study in New Zealand · Mukerji S, Ryan P, Simmonds H et al. · The New Zealand Medical Journal · 2024. https://doi.org/10.26635/6965.6510 16. Guideline for management of septic arthritis in native joints (SANJO) · Ravn C, Neyt J, Benito N et al. · Journal of Bone and Joint Infection · 2023. https://doi.org/10.5194/jbji-8-29-2023 --- This page is general information, not a diagnosis or a treatment plan for you. For advice about your own feet or legs, see a podiatrist or your doctor. In an emergency, call 000.