How do I reduce foot swelling from gout?

Managing Foot Swelling from Acute Gout

For acute gout with foot swelling, immediately initiate treatment with NSAIDs (such as indomethacin), corticosteroids, or colchicine, combined with rest and topical ice application to the affected joint to reduce inflammation and swelling. 1, 2, 3

Immediate Non-Pharmacological Interventions

Rest and ice are essential first steps:

• Apply topical ice directly to the swollen foot joint to reduce inflammation 3
• Rest the inflamed joint completely—avoid weight-bearing activities during the acute attack 3
• Elevate the affected foot when possible to help reduce swelling

First-Line Pharmacological Treatment for Acute Swelling

NSAIDs are the preferred initial treatment:

• NSAIDs are first-line agents for acute gout attacks when no contraindications exist 1, 2
• The most critical factor for success is starting treatment immediately—the sooner you begin, the better the outcome 3
• Indomethacin is commonly used and effective for relieving pain, fever, swelling, redness, and tenderness of acute gouty arthritis 4
• Continue NSAID therapy until symptoms resolve, typically several days 1

Alternative options if NSAIDs are contraindicated:

• Colchicine: Use low-dose regimen (1.2 mg initially, then 0.6 mg one hour later) to minimize gastrointestinal side effects 2
• Corticosteroids: Either oral, intravenous, or intra-articular injection depending on severity and patient factors 1, 2
• Intra-articular steroid injection is particularly effective and safe for severe mono-articular attacks 1

Preventing Future Swelling Episodes

Address modifiable risk factors immediately:

• Limit alcohol consumption, especially beer, which significantly increases gout risk 1, 5, 2
• Reduce intake of purine-rich foods including organ meats and shellfish 5, 2
• Avoid beverages sweetened with high-fructose corn syrup 5, 2
• If overweight, pursue weight loss—a 5% BMI reduction decreases recurrent flare odds by 40% 5, 2

Consider dietary additions that may help:

• Increase consumption of low-fat or nonfat dairy products, which have protective effects 2, 6
• Cherry or cherry juice extract may reduce attack frequency 6
• Vitamin C supplementation may help lower serum uric acid 6

Long-Term Management to Prevent Recurrent Swelling

Urate-lowering therapy is indicated for recurrent disease:

• Start urate-lowering therapy only after multiple attacks (≥2 per year), presence of tophi, or radiographic changes—not after a first attack 1, 2
• Allopurinol is first-line therapy: Begin at 100 mg daily and increase by 100 mg every 2-4 weeks until serum uric acid reaches below 6 mg/dL 1, 2, 7
• Maximum dose is 800 mg daily; adjust dosing in renal impairment 1, 7
• Target serum uric acid below 6 mg/dL (360 μmol/L) to prevent crystal formation and promote crystal dissolution 1, 8

Critical prophylaxis during urate-lowering initiation:

• You must provide prophylaxis with colchicine (0.5-1 mg daily) or NSAIDs during the first months of urate-lowering therapy to prevent paradoxical flares that occur from urate mobilization 1, 2, 8
• Continue prophylaxis for at least 3 months after achieving target uric acid levels in patients without tophi, or 6 months in those with tophi history 9

Common Pitfalls to Avoid

Do not make these mistakes:

• Starting urate-lowering therapy during an acute attack can worsen symptoms—wait until the acute episode resolves 3
• Discontinuing urate-lowering therapy after symptom improvement leads to recurrence in 87% of patients within 5 years 8
• Using high-dose colchicine regimens causes unnecessary gastrointestinal toxicity—low doses are equally effective 1, 2
• Failing to provide prophylaxis when starting allopurinol will trigger acute flares 2, 8

Monitoring Requirements

Regular follow-up is essential:

• Monitor serum uric acid levels regularly to ensure maintenance below 6 mg/dL 5, 2
• For severe gout with tophi, target even lower levels below 5 mg/dL to accelerate crystal dissolution 8
• Maintain lifelong urate-lowering therapy once initiated—this is a chronic condition requiring ongoing management 2, 8