Is It Gout or a Bunion? How to Tell the Difference
Gout vs. a bunion
What is that protruding, painful, and swollen knob near the base of your big toe? Could it be a bunion? Gout? Although they both hurt and throb, from a medical perspective, the difference is clear.
A bunion is more like a mechanical issue in which the big toe pushes against the second one and you end up with a bulge on the inside of the foot. But for the person who has pain and tenderness near the outside base of the big toe, it may be hard to know the difference.
Here’s the breakdown of gout vs. bunions—plus, the causes, symptoms, treatments, and how to try to prevent both.
What is gout? Symptoms, treatments, and more
Gout causes sudden and intensely painful inflammation in a joint, and it’s the result of the accumulation of a waste product called uric acid. This may happen for a few different reasons.
The body can make too much uric acid, or the kidneys may not get rid of enough uric acid. Most commonly, this is due to genetics. Some people are just more sensitive to foods and drinks high in purines, which the body turns into uric acid.
Foods and drinks especially high in purines include red meats, certain seafood, high-sugar food and beverages, and all types of alcohol.
As uric acid breaks down, it forms tiny needle-like, painful crystals which settle into joints just about anywhere—in the knee, foot, ankle, hand, wrist, elbow, or fingers, but it often targets the big toe.
(Here’s what to do if you think you have gout in your ankle.)
You may feel absolutely fine during the day, but like a bad nightmare, gout typically strikes at night, causing pain so intense you can’t go back to sleep. The pain may be so severe it incapacitates you.
A gout attack may last a few days to a week or even longer. Some medication works to speed up relief and healing for a gout attack; other medications work to lower uric acid in order to prevent future gout attacks.
(This is what it’s really like to live with gout.)
With all the places gout can go, there’s an interesting reason it typically settles in the toe.
“Gout targets the foot as the most dependent part of the body because it is cooler. At cooler temperatures, uric acid turns into crystals. Since the toe is farthest from the heart and the coolest, this is the most common spot,” says Victoria Seligman, MD, a rheumatologist with UCHealth Cherry Creek-Rheumatology Clinic in Denver.
Cooler temperatures are also one of the reasons experts think gout attacks happen so much at night.
“Other theories include [a link to] sleep disorders such as sleep apnea that causes less oxygen in the blood,” adds Dr. Seligman.
Other gout symptoms often include:
- Rapid onset intense pain, typically with no warning signs. The worst pain is within the first 24 hours.
- Pain is often described as like being stabbed with tiny, hot knives.
- Increased sensitivity on the skin over the affected joint. Even the lightest of fabrics can bring forth extreme pain.
- Swelling in the joints from the uric acid crystals
- Diminished joint function due to pain, tenderness, and swelling. It may be difficult to put weight on the affected foot or knee.
Who gets gout?
Gout was once known as the disease of kings (and queens). Actually, this applied to anyone wealthy enough to eat purine-rich foods, like red meat and certain seafood. Yet that’s only a part of the reason people get gout.
“There is a genetic component, so certain ethnicities are more at risk and those with immediate first-degree relatives in particular. People that have higher body mass indexes (BMIs) in the obese range are also at risk,” adds Dr. Seligman.
Those higher BMIs are thought to be a significant factor for the spike in gout cases since the 1990s.
A 2017 study published in Arthritis and Rheumatology revealed that overweight people were 85 percent more likely to have higher levels of uric acid than people who were at a healthy weight, which can contribute to the prevalence of gout.
Other factors for developing gout are:
- Being male (men are about five to 10 times more likely to get gout)
- Age (commonly starts between the ages of 30 and 50)
- Postmenopausal women (as female sex hormones decline, so does the protection against uric acid levels)
- Heavy, regular consumption of alcohol
- Regularly consuming high-purine foods
- Frequently eating and drinking foods with high sugar content
- Certain chronic health conditions such as high blood pressure, diabetes, congestive heart failure, kidney disease, and metabolic syndrome
- Medications that can lead to higher uric acid levels such as diuretics and immunosuppressants.
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Treatment for gout
Gout is a life-long condition with no cure, but it can be effectively treated and managed.
A gout attack typically prompts that first visit to the doctor for diagnosis and a prescription to treat acute pain. Some people may only have a gout attack once a year, while others may have several. Gout attacks or flare-ups are something that you don’t want to wait out.
“The best thing to relieve pain at onset is to start medications with the onset of symptoms,” says Dr. Seligman.
Your doctor may write you a prescription for anti-inflammatories such as colchicine (Mitigare, Colcrys) to treat a flare-up, or you may have success with over-the-counter anti-inflammatory drugs such as Motrin, Aleve, or Advil. They may also recommend corticosteroid pills or injections.
In addition to taking medicine, try icing the area for about 10 minutes per session. Keep the affected area elevated, and give yourself permission to relax and not use the affected joint too much. (You might want to try out these natural remedies for gout.)
Once the pain is gone, the next step in treating gout is addressing the causes and learning how to fend off future attacks.
Preventing gout flare-ups
In some cases, your doctor may suggest medication to prevent inflammation and help lower uric acid.
But as it is with many health conditions, confronting lifestyle factors is key. For gout, that’s avoiding foods and drinks that contribute to high uric acid levels.
When it comes to the meat department, limit high-purine sources, namely bacon, veal, venison, liver, and turkey. And restrict seafood menu items of sardines, anchovies, herring, codfish, trout, haddock, scallops, and muscles. It also helps to cut back on high fructose beverages and wine, liquor, and beer.
Eating and drinking foods that are lower in purines is helpful, but that’s just part of the prevention plan.
“There is growing evidence that gout is part of a metabolic syndrome and responsive to weight gain. Therefore, a healthy diet that promotes weight loss can be beneficial to gout,” says Dr. Seligman. That includes diets that are higher in dairy, too, she says.
Complications from gout
A gout attack is incredibly painful and scary, so in all likelihood, people won’t delay seeking treatment, whether they think it’s an injury or something else.
However, left untreated, repeated gout flare-ups can cause some joint and bone issues. Namely bone erosion, and sometimes joint stability and function are at risk with severe untreated gout, Dr. Seligman says.
A condition called tophi may develop due to urates—large lumps of uric acid crystals—that form visible hard lumps under your skin. Long-term gout that isn’t treated may eventually develop into gouty arthritis, which can cause persistent pain, joint damage, and joint deformity.
What is a bunion? Symptoms, treatments, and more
A bunion is a progressive bone disorder. Several factors contribute to their growth, including wearing poorly-fitted shoes (such as high heels), medical conditions (like rheumatoid arthritis), or a family history of problems involving foot anatomy.
A bunion often begins as a small bump at the base of the big toe (known as the metatarsophalangeal joint) and forms from the bone or tissue at the big toe joint moves out of place.
The big toe is forced to lean toward the other toes, causing what looks like a lump of bone on the foot that is often painful.
If bunions are ignored, they can cause difficulty when walking. There are other types of bunions including a bunionette (also called a tailor’s bunion) which forms outside the foot along the pinky toe.
With simple modifications, like wearing wider shoes or toe spacers, the bunion may not hurt at all. Whether there is pain or not, once a bunion forms, it is permanent unless it is removed by surgery to relieve symptoms or correct the deformity.
Unlike a gout attack, which is more waxing and waning and is typically relieved by a short course of medication, bunion pain can be more longstanding, explains podiatrist Jacob Wynes, DPM, assistant professor, department of orthopedic surgery at the University of Maryland School of Medicine.
When it comes to bunions, Dr. Wynes says the pressure from too narrow and tight shoes can cause pain while the shoes are on and after you take the shoes off.
Common bunion symptoms include:
- A painful and tender bony bump at the base of the big toe
- Big toe pain
- Redness and swelling at or near the bump
- Calluses under the ball of the foot
- Hardened skin on the bottom of the foot
- A callus or corn on the bump
- Difficulty walking
Who gets bunions?
We often think bunions come from cramming our feet into shoes that are too tight day after day—including uncomfortable high heels. This is a significant factor, but there are other things that raise the risk for developing bunions, Dr. Wynes says.
For example, if you have loose ligaments where the metatarsal bone (the long bone that connects your toes to the ankle) swings toward the second toes, it can push back on the metatarsal bone, making a barely noticeable bunion worse over time, Dr. Wynes explains.
Other reasons bunions may develop:
- Aging (One out of every three people over 65 have a bunion.)
- Flat feet
- Low or weak arches
- Rheumatoid arthritis
Treatment for bunions
There are several things you can do to alleviate the pain and tenderness that come from bunions. Just keep in mind, even the most promising bunion pads and splints won’t “cure” bunions. Bunions are permanent.
“It’s important to note that there is no splint or other over-the-counter device that can return a bunion to a straight position, even when used over time,” says Christopher Kidd, MD, an orthopedic surgeon at Cedars-Sinai Kerlan-Jobe Institute. And timing is everything.
Address bunions early to slow down a bunion’s progression. Still, “most mild bunions can be treated very effectively with toe pads, toe spacers, and wearing wider shoes,” says Dr. Kidd.
These can go a long way in easing pain and the progression of a bunion deformity. And they are the first course of treatment a podiatrist is likely to recommend before resorting to surgery.
Here’s some podiatrist-approved ways to treat bunion pain at home:
- Try moleskin and gel-filled bunion pads to help by redistributing pressure away from the affected joint. However, if they constrict the toes rather than relieve pressure, don’t use them.
- Consider a toe spacer or “bunion corrector” placed between the big toe and second toe to prevent them from rubbing together.
- Replace shoes that are too narrow. Instead, buy low-heeled shoes with plenty of space for the widest part of your foot and enough room in the toe box so they’re not squeezed together.
- Be sure new shoes have a supportive arch to transfer force away from the bunion. A custom orthotic may be more effective.
- Bunion splints help prevent the big toe and the second toe from pushing against each other. Usually, these are worn at night to reduce pressure between the toes and reduce pain.
- Try bunion exercises to strengthen muscles and tendons surrounding the big toe to minimize pain from an abnormal range of motion of the big toe.
- Ice bunion for 10 minutes nightly to reduce inflammation
Usually, bunion pain is significantly reduced by using the tips mentioned. Yet, “while custom orthotics or insoles can prevent the progression of bunion deformity, longstanding correction is usually achieved through surgery,” says Dr. Wynes.
Your doctor may suggest bunion surgery after you tried everything else if your pain is persistent or getting worse. Sometimes surgery is necessary because a bunion triggered other foot problems like bursitis, hammertoe, a bunion under the pinky toe, or pain in the ball of the foot.
There are various bunion procedures depending on the patient’s goals and severity of the deformity.
If bunion surgery is needed for both feet, just one foot is done at a time, as many procedures require prolonged periods of being off the foot, sometimes in a splint or cast.
How to prevent bunions
Take these steps to help ward off bunions, or at least slow down the progression of bunions:
- Choose shoes with a wide enough toe box, so your toes aren’t crammed close together.
- Try on shoes in the afternoon, when your feet have experienced their fullest swelling of the day, so you don’t buy them too small.
- If you have flat feet, buy shoes specifically for flat feet. For shoes you can’t part with, get custom orthotics from your podiatrist.
- If you see signs or symptoms of a bunion, don’t delay treatment. See your doctor for evaluation and a treatment plan.
When a bunion develops and isn’t treated, it has the potential to wreak havoc on the smaller toes.
“Bunions can push the second and third toes off their joints, causing pain and deformity which can be more difficult to fix,” says Dr. Kidd.
Severe bunions can cause balance problems with walking, problems with fitting and wearing shoes comfortably, hammertoes, painful toes and calluses, and tailor’s bunions.
“Patients who have problems with circulation or sensation in their feet can also develop calluses and friction wounds because their toes rub on their shoes. In rare cases, these can cause serious infections,” adds Dr. Kidd.
If you aren’t sure what’s making your feet ache, make an appointment as soon as possible with your doctor. There are plenty of solutions for both gout and bunions, but you may need a professional’s help to find relief.
- Victoria Seligman, MD, MPH, a rheumatologist with UCHealth Cherry Creek-Rheumatology Clinic in Denver
- Christopher Kidd, MD, orthopaedic surgeon at Cedars-Sinai Kerlan-Jobe Institute
- Jacob Wynes, DPM, MS, FACFAS, assistant professor, department of orthopedics, University of Maryland Medical System
- Arthritis and Rheumatology: "Prevalence, Incidence, and Years Lived With Disability Due to Gout and Its Attributable Risk Factors for 195 Countries and Territories 1990–2017: A Systematic Analysis of the Global Burden of Disease Study 2017"
- Primary Care: Clinics in Office Practice: "Diagnosis and Treatment of Gout and Pseudogout for Everyday Practice"
- Arthritis Foundation: "Which food are safe for gout?"
- Institute for Quality and Efficiency in Health Care: "Bunions: Overview"