| What We Treat
Gout
Gout comes on over hours, not days, and is often mistaken for infection. It is highly treatable, and repeated attacks damage the joint permanently.
Overview
What It Is
Gout is caused by urate crystals forming in a joint, producing an intensely painful, red, swollen joint over a few hours. The base of the big toe is the classic site, but the knee, ankle, midfoot and hand are all common. Between attacks the joint may be entirely normal, which is part of why it gets missed.
Rapid and Intense
Maximum pain within six to twelve hours, red and hot, so tender that a bedsheet is unbearable. Usually one joint.
Symptoms
How It Tends to Feel
These are the features that point towards this diagnosis rather than another:
Rapid Onset
Maximum pain within six to twelve hours, often waking you in the night.
Red and Hot
The overlying skin is visibly red and warm, and may peel as it settles.
Exquisite Tenderness
Even light touch, including bedclothes, is unbearable.
Single Joint
Usually one joint at a time, most often the base of the big toe.
Resolution Between Attacks
The joint returns to normal, which distinguishes it from most arthritis.
Tophi
Firm lumps around joints or the ear in longstanding, poorly controlled disease.
Causes & Risk Factors
What Drives It
The usual contributors, in rough order of how often they turn out to matter:
Raised Urate
The underlying requirement, though many people with high urate never get gout.
Diet and Alcohol
Beer, spirits and purine-rich foods raise urate. Their role is real but often overstated.
Medication
Diuretics in particular are a common and modifiable contributor.
Kidney Function
Most urate is cleared renally, so reduced function raises levels.
Metabolic Syndrome
Strongly associated, and worth screening for.
How We Can Help You
Treatment & Management
Treatment is built around what the assessment finds, but generally follows this shape:
When to Seek Help
Red Flags — Don’t Ignore These
Most presentations are straightforward. These features are the exceptions, and warrant prompt assessment:
⚠ Seek Medical Advice If You Notice
- A hot, swollen joint with fever or feeling systemically unwell — septic arthritis must be excluded urgently
- A first attack in someone already unwell or immunosuppressed
- Multiple joints affected at once
- Attacks becoming more frequent despite treatment
If any of these apply, contact your GP or seek urgent medical care rather than waiting for a physiotherapy appointment.
Common Questions
Frequently Asked Questions
How do you tell gout from infection?
Often you cannot on examination alone, and that matters because septic arthritis is an emergency. A hot swollen joint with fever needs urgent assessment rather than a wait-and-see approach.
Is it caused by diet?
Diet contributes but is rarely the whole story. Genetics and kidney function matter more, which is why dietary change alone often fails to prevent attacks.
Can physiotherapy help?
Not during the acute attack, beyond advice on offloading. Afterwards it restores the movement, strength and walking pattern that a painful attack disrupts.
Not Sure If This Is What You Have?
An assessment will tell you what is actually going on and what to do about it. I see everyone myself, and you will leave with a plan rather than a leaflet.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. If you’re experiencing any of the warning signs above, contact your GP or seek emergency medical care as appropriate.