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Advanced Podiatric Procedures & Services in Los Angeles, CA


Gout is an extremely painful form of arthritis. It can affect anyone at any time. Gout affects each person differently. For some, the pain may be severe and sharp, while other people may experience a dull, throbbing pain that comes and goes. Much like rheumatoid arthritis joints that have gout are warm to the touch swollen. The area can be extremely sensitive to touch with even the slightest amount of pressure causing excruciating pain.


Gout is the result of very high levels of uric acid in the bloodstream. Uric acid is produced by the body from purines. Purines are natural substances that are found in the body. They are also found in many of the foods you eat, including:

  • Alcoholic beverages
  • Beverages sweetened with fructose
  • Seafood
  • Steak
  • Organ meats

In most cases, uric acid is broken down naturally while in the bloodstream and is eventually passed through the kidneys and voided with the urine. If your kidneys don't filter enough uric acid out of your blood or your body produces more than it needs, uric acid levels will begin to increase and small crystals will begin to form. These “urate” crystals are extremely sharp and shaped like needles. If they become lodged in the joint, pain and swelling will occur.

Signs and Symptoms

Gout symptoms normally occur at night and can come on suddenly without any warning. The condition is found most often in the joint at the base of the big toe, but can actually occur in joints throughout the body. Gout has been reported in the elbows, wrists, fingers, and ankles. The most severe pain often occurs during the first few hours of an attack and may last up to 12 hours or longer.

The joint will become red and swollen, causing extreme sensitivity to the touch. As the condition worsens, your range of motion and flexibility will gradually decrease and make it almost impossible to bend or move the joint without pain. Gout attacks can last for days or even weeks, characterized by a dull, lingering pain. The longer attack goes on, the more likely it is that other joints will start to be affected.

Diagnosis and Risk Factors

Your doctor will perform a thorough examination and may collect a sample of fluid from your joint. The fluid will be tested to determine if uric acid crystals are present. Combined with that information and a review of your medical history, your doctor can make an accurate diagnosis for gout. If you are overweight and have health conditions like high blood pressure, diabetes, kidney or heart disease, you may be at a much higher risk than others.

Your diet will also play a role in whether or not you are at risk for gout. Drinking beer and sugary beverages may dramatically increase your risk. Having a family history where other members of your family suffered from the disease will also increase your risk. Your gender and age must also be considered. Men are more commonly diagnosed with gout and at a much earlier age than women. Women who have passed through menopause are at a higher risk than women who are pre-menopausal. Gout may also be a problem if you have recently experienced any type of physical trauma or a surgical procedure.

Treatment Options

If you believe you are experiencing a gout attack, see Dr. Leonora Fihman as soon as possible. Without treatment, the buildup of urate crystals can lead to joint damage and chronic pain. Intense heat and pain within a joint can be a sign of infection. Immediate treatment is necessary if you want to eliminate the infection and speed up the healing process. If your gout is severe, you may be sent to a rheumatologist for treatment.

Your doctor will evaluate your condition and based on its severity, may offer the following treatment options:

  • Corticosteroids and NSAIDs to reduce the inflammation within the joint and help to manage your pain
  • Colchicine will help to minimize your pain and overall discomfort
  • Medications that lower the production of uric acid within the body
  • Medications designed to flush uric acid from the body

Dr. Fihman will also recommend many lifestyle changes that will work to lower your risk of having a gout attack. These lifestyle changes will include improving your diet by including fresh fruits and vegetables and eliminating foods that are known to trigger gout attacks. You may also be asked to reduce your intake of alcoholic beverages. Losing weight and eliminating smoking will also help.

Self Care

If you know you have a strong family history of gout and have two or more risk factors, it's important to work with Dr. Fihman to reduce the severity of your gout attacks. Some people claim that drinking cherry juice can reduce the pain and discomfort of gout. The Vitamin C and other nutrients in the juice will help to fight infection and may actually work to break down the uric acid crystals within the joint.

If you are diagnosed with gout, it's important that you begin to take steps in self-care as soon as possible. Get the rest you need and follow your doctor's orders. Take the corticosteroids, NSAIDs, and other medications as directed. This will help to reduce your pain and discomfort and will also allow the swelling to go down. As the swelling diminishes, your range of motion and flexibility will return. Once you can move effectively without pain, gradually begin to exercise. Walking, stretching and swimming (or any other aquatic exercise) will be beneficial at keeping the joint moving.


Because gout is often triggered by the foods you eat and common lifestyle habits, you may be able to prevent future attacks by making simple changes. Improving certain lifestyle habits will inevitably help in correcting others. A good example of this is changing your diet and including more exercise. By eliminating fatty foods and those that are highly processed, you will also eliminate many of the triggers that can cause a gout attack. Adding more fresh fruits and vegetables will help to reduce your risk of infection and provide your body with the nutrients it needs to function more efficiently.

Exercising at least three days a week and improving your diet will help you to shed unwanted pounds. While these habits may take some time to change, any additional pounds you may carry will soon start to drop away. Maintaining a healthy weight is one more way to reduce your risk of a gout attack. As you begin to make these changes, you may start to notice that your gout attacks come much less frequently and that they are less severe. They may also be shorter in terms of duration.

If you smoke, take the steps necessary to stop. Smoking restricts your circulation and can make it difficult for your joints to get the nutrients they need. Eliminating smoking and increasing the amount of time you spend exercising will improve your circulation. Swimming is a great way to exercise when you have gout. If you can stand the pressure of the water on the joint, you can exercise while placing very little weight on the affected area. The water may also be able to soothe the joint and reduce the swelling.

During exercise, it's important to stay as hydrated as possible. While it's important to drink plenty of water during exercise, it's important to stay hydrated at other times as well. Drinking plenty of fluids helps to flush out the excess amounts of uric acid and can help prevent the formation of urate crystals. Drinking fluids will also help to support healthy kidney function.

Dr. Leonora Fihman

Dr. Leonora Fihman is a board-certified podiatrist who serves individuals throughout Southern California, including Beverly Hills, Encino, Hollywood, and many other communities and neighborhoods throughout the Los Angeles area. She can effectively diagnose and treat gout and many other health conditions that affect the feet. With her mobile concierge service, she is capable of treating patients either in her office or in their home, whichever is most convenient for them. Once you make your appointment with the doctor, she will be able to review your medical records and family history and work with you to find a diagnosis that identifies the cause of your problems.

She can effectively treat the cause of your pain and provide you with suggestions on how to prevent further attacks. If gout persists, she will continue to investigate additional treatment options until your symptoms are gone and you are back on the road to good health. Dr. Fihman knows how painful gout can be. She encourages all of her patients who may be suffering from an attack, to contact her office at 818-798-1919 and schedule an appointment at their earliest convenience.



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