Uric acid deposits in feet.

[richmc4478]

I’ve what I suspected to be gout flare ups twice before in single feet each time, only affecting the ankles mainly. This last time it was after a heavy night on the beer… both feet (mainly ankles again) were agony for 4/5 days. I noticed that after the pain subsided I had a hard lump where my second toe joins my foot and 2 more on joints near the ankle and top of foot. Each one appeared suddenly. I’ve been to my Dr who suspected gout, X-rays showed no serious bone issues so Dr is now convinced these bumps/lumps are uric acid. I’m getting a precautionary MRI next week. A friend said he had similar and the pain is often the acid working it’s way to the surface (???). Anyone else have similar and how did you resolve? Thanks

[nobody]

The most useful bit of information to make useful guesses about your case would be the amount of uric acid in your blood, something which is easily and routinely tested.
Unless perhaps you have unusually severe gout, I doubt these lumps actually are uric acid. Likewise I very much doubt uric acid working its way anywhere is what’s causing your pain. Your troubles might or might not be caused by uric acid, but if they are it’s most likely by the way of inflammation.
Inflammation can often be controlled with judicious use of anti-inflammatory drugs but the underlying cause should of course be treated as well.

I’ve had lumps as well (typically painless). So far as I know they’re harmless. Perhaps something like that within the ankle could cause trouble for instance. But as far as one can tell without an MRI (which I’ve never had for the foot or ankle), inflammation is the problem.

[richmc4478]

UPDATE.

Got a uric acid blood test and it came back as 10.1 so really quite high. The creatinine and urea were both within range so Dr suspects it’s diet… I have been doing Keto for last 6 months… although this doesn’t explain the flare ups I’ve had previously.

He has asked me to control my diet for a month then he will retest me. 🤷🏻‍♂️

[nobody]

Keto and beer probably make this worse but you normally don’t solve a 10.1 by changing your diet (though it would help). It makes sense to retest anyway because the first result could be a fluke.
Out of curiosity, what has your doctor told you to do about your diet?
I guess the lumps could actually be uric acid with such a high result. A drug such as allopurinol is probably going to be the only way to solve this before it gets worse.

[richmc4478]

The Dr hasn’t suggested anything in particular for now, he’s sceptical about Keto and low/no carb diets as he admits he doesn’t fully understand the effect this will have on cholesterol (good/bad or oxidised). My wife is Italian who has been pushing the Mediterranean diet for years, but I had my first ever gout flare whilst I was a vegetarian (gave up due to feeling lousy and not understanding all the supplements required). The Dr has talked about upping my hydration and replacing animal fats with more vegetable fats seeing as I want to remain relatively low carb. I’m due to be mountaineering in the Himalayas from mid-March to end of May so I’m reluctant to start any new medication, especially allopurinol, i admit I’m ignorant about it’s effectiveness, I’ve just heard the horror stories… but as with all of these things nobody tells the story when the drugs work… just when they go wrong… but I do tend to avoid medication anyway, however permanent joint damage or organ damage vs taking a pill everyday may be a small price to pay.

I have an appointment with the dr tomrrow so I’ll update afterwards

[nobody]

A few random musings:
It seems quite common for people to develop gout on aggressive low-carb diets. This is probably in part due to inadequate hydration and your doc is to be commended for addressing that.
A low-carb diet is very different (and much safer, unless you’re epileptic or diabetic) from a no-carb or keto diet in terms of its effect on your metabolism.
You can’t tell which diet is right by the flares, unless you stick to it for years (or at least more than 6 months).
There are no supplements required for a vegetarian diet, unless you actually mean a vegan diet which I would generally not recommend to people who have a uric acid problem.
An old-fashioned vegetarian diet on the other hand is often helpful (depending on the details) but simply replacing animal fats which vegetable fats is unlikely to help with uric acid. That said, if you pick the right fats (such as olive oil) that may help your cholesterol and generally be healthier. Some fish fat is also generally recommended (though that may increase uric acid).
Allopurinol is trouble, especially when you start it. That’s not some kind of legend. But not taking this type of drug with a uric acid as high as yours is trouble as well… typically much worse trouble in the long run.
What are you going to do in the Himalayas if you get a flare worse than anything you’ve experienced so far? Be sure to pack effective anti-inflammatory drugs you know you can tolerate! You might also ask your doctor about taking a daily colchicine pill starting a few days before your trip until you’re back somewhere where gout would be less inconvenient.

[richmc4478]

Thanks for your insights. I’m fairly new to this, I didn’t put the old flares down to gout until I got the high uric acid diagnosis.

Thankfully my flares are usually closer to years apart as opposed to months or weeks and the last was triggered by a night of heavy beer drinking after fasting most of the day so I think if I keep my hydration up and avoid alcohol which will be easy as I’ll be on Everest. Anyway, I’ll se what the Dr says tomorrow and take it from there… but I think I’ll take the strongest anti-inflammatory meds I can get with me and there’s plenty of strong painkillers to be had there.

Of interest, not sure if you’ve heard any anecdotes about this but this last flare was preceded by random muscle and joint aches from the exact day I got COVID and lasted a few weeks afterwards. I’ve seen others mention this and the sudden onset of tophi after COVID vaccination too.

[nobody]

Colchicine seems to work to prevent severe COVID as well so there seems to be some kind of connection. The worst effects of COVID are autoimmune after all, same as gout.
I’d say anything that gets the immune system worked up (such as food you’re mildly allergic to or indeed a vaccine) could potentially trigger gout.

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