Gout vs Capsulitis

by Dr. Emily Splichal, DPM MS

For the past several days you have been experiencing extreme pain, redness and swelling around your great toe joint.  After a quick google search, you are convinced you have gout.  

But with no family history of gout or prior sensitivity to red meat or alcohol, you are left uncertain of your diagnosis. 

What is Gout?

Gout is a type of inflammatory arthritis that is caused by elevated levels of uric acid.  The classic presentation of gout is a rapid increase in extreme pain and redness around the great toe joint, with many patients stating it first occurs in the middle of the night.

Despite the classic presentation of gout, the condition is not as common as patients may think it is.  With only 4% of the population diagnosed with gout, this painful presentation is what doctor’s call the “great imitator” and even though it may look and feel like a gouty attack most cases are not.

Considering Capsulitis

Besides gout, the most common cause of pain in the great toe joint is a capsulitis or synovitis. With every step we take, the great toe joint transfers 2.5x our body weight in ground reaction forces.  If the joint mechanics are not properly coordinated or improper shoes are worn, this load to the joint can cause stress to the joint surface or capsule.

Capsulitis of the great toe joint presents as pain, redness and swelling with a sudden onset.  To the unexperienced patient, this painful presentation can feel exactly like a gout attack.  

Gout vs Capsulitis Treatment

The good news is that in many cases the treatment for both a gout attack and capsulitis are almost exactly the same - minimize stress to the joint and reduce inflammation. 

Stress can be reduced in a joint by limiting walking and flexion of the joint and wearing a stiff soled shoe or surgical shoe.  In addition, inflammation can be reduced with the use of oral NSAIDs, cortisone injections or natural supplements such as systemic enzymes. 

If you are experiencing any pain around your great to joint or uncertain of the cause of your foot pain, see a Podiatrist who can appropriately evaluate your foot.