Gout is a common type of inflammatory arthritis that causes sudden, intense joint pain and swelling. In this guide, you will learn what gout is, why it happens, who is at higher risk, how we diagnose it, and the treatments that help you feel better and prevent future flares.
What Is Gout?
Gout happens when uric acid builds up in the blood and forms needle-like crystals inside a joint. Your immune system reacts to those crystals, which triggers sudden pain, redness, heat, and swelling. The big toe is the classic spot, but gout can affect the midfoot, ankle, knee, wrist, fingers, and elbow.
How Gout Feels
Sudden, severe pain that often starts at night.
Redness, warmth, and swelling at one joint.
Extreme tenderness where even a bedsheet can hurt.
Stiffness and limited motion during and after a flare.
With long-standing gout, firm bumps under the skin called tophi can develop.
Why Gout Happens
Uric acid forms when your body breaks down purines, which are found naturally in your tissues and in certain foods. When production is high or your kidneys don’t clear enough uric acid, crystals can deposit in joints and surrounding tissues. Cold areas like the big toe are common sites for crystal formation.
Who Is at Higher Risk?
Age and sex: more common in men and after menopause in women
Family history of gout or high uric acid
Chronic kidney disease or reduced kidney function
Metabolic conditions: obesity, insulin resistance, high blood pressure, high triglycerides
Medications: diuretics for blood pressure, low-dose aspirin, cyclosporine, tacrolimus
Dietary factors: frequent alcohol use, especially beer and spirits, red and organ meats, certain seafoods like anchovies and shellfish, and sugar-sweetened beverages with fructose
When to Seek Care
If you notice a new hot, swollen joint or have repeated gout flares, seek care promptly from a clinician or urgent care provider. Early evaluation helps confirm that gout is the cause, guides fast pain relief, prevents infection or other problems, and protects the joint from lasting damage. A clinician will review your health history and medicines to choose safe, effective treatment and avoid drug interactions.
Severe joint pain with redness and warmth
Fever or feeling unwell along with a hot, swollen joint can signal a joint infection (septic arthritis). Seek urgent same-day medical evaluation to rule out infection before receiving steroid injections or NSAID-only treatment.
Recurrent attacks in the same or different joints
Hard nodules near joints or the ear rim that may be tophi
How We Diagnose Gout
During your visit, a clinician will look at the painful joint and review your overall health, symptoms, and medicines. The best way to confirm gout is to take a tiny sample of joint fluid and check it under a microscope for uric acid crystals. This test helps rule out infection and other problems that can look like gout.
Joint aspiration and crystal analysis when possible
Blood tests, including uric acid level, kidney function, and markers of inflammation
Imaging when needed: ultrasound can show a double contour sign, X-rays reveal long-term changes, and specialized CT may identify crystal deposits
Treating an Acute Gout Flare
Flares respond best when treatment starts early. The main goal is to ease pain quickly, reduce swelling, and lower inflammation while protecting the affected joint from more harm. Your doctor will tailor medicines to your health history and current medicines to ensure safety and effectiveness and help you return to daily activities.
Anti-inflammatory medicines such as NSAIDs, if safe for you
Colchicine, especially when started soon after symptoms begin
Corticosteroids by mouth or a targeted joint injection
Rest, elevation, and ice for comfort
Do not stop your long-term urate-lowering medicine during a flare unless your doctor advises it. Let us know at the first sign of a flare so we can tailor treatment to your health history and medications.
Preventing Future Attacks
If you have repeated flares, tophi, kidney stones from uric acid, or moderate to advanced chronic kidney disease, you may benefit from urate-lowering therapy. The aim is to keep your blood uric acid below target so crystals dissolve and flares fade over time.
Topic
Key Points
Who Should Start Urate-Lowering Therapy
2 or more flares per year, tophi, uric acid kidney stones, or chronic kidney disease stage 3 or higher
First-Line Medicine
Allopurinol is typically first choice. Start low and increase gradually. Febuxostat is another option if needed. In patients with established cardiovascular disease, febuxostat carries an FDA boxed warning for increased risk of cardiovascular death. Use only after shared decision-making, and consider allopurinol first. Allopurinol can rarely cause severe cutaneous adverse reactions. Consider HLA-B*58:01 testing in high-risk groups (e.g., Han Chinese, Thai, Korean patients with CKD, and African American patients) before starting therapy.
Other Options
Probenecid may help if kidney function is adequate. Pegloticase is reserved for severe, refractory cases. Less effective with moderate-to-severe CKD; avoid or use cautiously in patients with a history of uric acid kidney stones; review for drug–drug interactions.
Target Uric Acid
Under 6 mg/dL is the usual goal. Under 5 mg/dL may be used if tophi are present.
Flare Prevention When Starting Therapy
Low-dose colchicine or an NSAID is often used for several months to reduce flare risk during dose adjustments.
Daily Steps That Help
Maintain a healthy weight and stay active within comfort
Limit alcohol, especially beer and spirits
Moderate high-purine foods like red and organ meats and certain seafoods
Cut back on sugar-sweetened drinks, especially those with fructose
Drink water regularly and review medications with your doctor
Possible Complications If Gout Is Not Treated
Tophi that can erode bone and limit joint motion
Progressive joint damage and arthritis
Uric acid kidney stones
How Princeton Orthopaedic Associates Can Help
Our team evaluates the painful joint, confirms the diagnosis, and builds a treatment plan that eases pain fast and prevents future attacks. When appropriate, we can perform joint aspiration or an image-guided injection and coordinate long-term urate-lowering therapy with your broader care team.
If you think you're having a gout flare or you've had recurrent attacks, schedule an evaluation. Getting ahead of flares now helps protect your joints for the long term.
This blog post is meant to be informative and should not act as a self-diagnosis tool. If you’d like to see one of our doctors, please contact us here.
If you're experiencing pain in the front of your lower leg, especially after running or engaging in high-impact activities, you could be dealing with shin splints. Shin splints affect many athletes, hikers, and fitness enthusiasts, causing discomfort and sometimes even limiting physical activity. If you're struggling with shin pain, you're not alone. But what are shin splints? Let's take a look at shin splints, what causes them, and how to recognize the symptoms and prevent them in the future.
What Are Shin Splints?
Shin splints, formally known as medial tibial stress syndrome (MTSS), refer to the pain felt along the inner edge of the shinbone (tibia). This condition happens when the muscles, tendons, and bone tissue around the tibia become overworked due to repetitive stress. Usually, shin splints occur in runners, but anyone participating in physical activities like hiking, basketball, or dance can develop this type of leg pain.
Shin Splints Symptoms
Recognizing the symptoms of shin splints is key to getting the right treatment.
The most common symptoms include:
A dull, aching pain in the shin: This pain is typically located along the front or inner part of the lower leg and can intensify during or after exercise.
Tenderness or soreness along the shinbone: Pressing on the affected area often causes discomfort.
Swelling in the lower leg: Some people experience mild swelling in the shins, particularly after exercising.
Shin pain that worsens with activity: As the condition progresses, the pain may worsen during physical activities like running or jumping and may persist even during rest
If you're experiencing any of these symptoms, it's important to take steps to reduce the pain and prevent further damage.
What Causes Shin Splints?
The primary cause of shin splints is repetitive stress to the lower leg. This stress can lead to inflammation of the muscles and tendons surrounding the shinbone, causing pain.
Some of the most common causes of shin splints include:
Sudden increases in physical activity: Ramping up your workout intensity or duration too quickly can place extra stress on your shins.
Running on hard surfaces: Pavement or concrete surfaces don't absorb impact well, increasing stress on your legs.
Improper footwear: Wearing worn-out or unsupportive shoes can contribute to shin splints.
Flat feet or high arches: These foot conditions can alter your biomechanics, placing more stress on the shins.
Poor running form: Incorrect running technique, such as overstriding or landing too heavily on your heels, can lead to shin pain.
Understanding the causes of your shin splints is important to help you prevent future occurrences.
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If you're wondering how to get rid of shin splints, the good news is that in most cases they can be treated at home with simple home remedies and changes to your workout routine.
Here are ways to care for shin splints at home:
Rest: The most important aspect of treating shin splints is giving your legs time to heal. Avoid high-impact activities that aggravate the pain, like running or jumping.
Ice the affected area: Apply ice packs to your shins for 15-20 minutes several times a day. This helps to reduce inflammation and pain.
Compression: Wearing compression sleeves can help reduce swelling and provide support to the affected area.
Elevation: Elevating your legs after exercise can help decrease swelling and improve circulation.
Over-the-counter pain relievers: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can reduce pain and inflammation.
How to Prevent Shin Splints
Preventing shin splints is crucial to avoiding recurrent pain.
Here are some strategies to keep your shin splints at bay:
Wear proper footwear: Invest in supportive running shoes. Get fitted for shoes that provide adequate cushioning and stability for your specific feet. Shoes that are worn-out and have lost their cushining and support can fail to properly absorb the impact of your foot hitting the ground. When that shock isn't absorbed by your shoes, it transfers more stress to your lower legs, increasing the risk of develping shin splints. Shoes that don’t provide adequate arch support or cushioning can contribute to shin splints, especially if you have flat feet, high arches, or other foot mechanics issues. Shoes designed specifically for your foot type and activity level can help distribute the forces evenly and prevent overloading your shins.
Stretch and strengthen: Regularly stretching your calves and strengthening the muscles in your lower legs can hlep improve flexibility and reduce your risk of developing shin splints.
Run on softer surfaces: Whenever possible, run on grass, trails, or a track instead of concrete or asphalt. Running on these softer surfaces can help reduce the impact on your legs, as these surfaces absorb more shock. This will lessen the stress put on your shinbones and surrounding tissues, lowering the likelihoo of developing shin splints. Running on hard surfaces increases your risk of developing shin splints. Surfaces like concrete and asphalt don’t absorb the impact of your steps, meaning the force is transmitted back up through your legs, putting additional stress on your muscles and bones which can lead to inflammation and pain in your shins.
Ease into new workouts: Gradually increase the intensity and duration of your exercise routine to give your body time to adapt.
Improve your running form: Pay attention to your stride and landing mechanics. Landing softly and maintaining a shorter stride can help distribute impact more evenly.
Dealing with Shin Splints: When to See a Specialist
If your shin splints aren't improving with rest and home treatment, or if the pain becomes severe, it may be time to see a sports medicine specialist. A sports med doctor can help determine if your shin splints are caused by an underlying issue like a stress fracture, or they may suggest more advanced treatment options.
Here are signs you should see a sports medicine doctor:
Pain persists despite rest and home care.
You experience severe pain even when not exercising.
Swelling in the shin area is increasing.
There's concern about a potential stress fracture.
Sports medicine specialists can perform imaging tests like X-rays or MRIs to rule out more serious injuries. They may also recommend other treatments such as physical therapy to help you strengthen the muscles around your shins, custom orthotics to correct any biomechanical issues, or even gait analysis to improve your running form.
What is Gait Analysis?
Gait analysis is a way of studying how you walk or run to understand your movement patterns. It looks at how your feet hit the ground, how your legs move, and how your body stays balanced. The goal is to identify any imbalances or issues that could lead to injuries, like shin splints or knee pain.
During a gait analysis, a specialist might watch you walk or run or use technology like a treadmill and cameras to get a detailed view. Based on the results, they might recommend specific shoes, insoles, or exercises to improve your form and reduce the risk of injury.
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Advanced Treatment Options for Shin Splints
If basic treatments aren't effective, your specialist may suggest advanced interventions. These may include:
Physical therapy: A physical therapist can guide you through exercises that strengthen the muscles supporting your shins and improve your flexibility.
Custom orthotics: If flat feet or high arches are contributing to your shin splints, custom shoe inserts can provide the support you need.
Long-Term Treatment and Prevention
Once you've recovered from shin splints, it's important to make long-term adjustments to avoid future injuries. Follow these tips:
Stick to a well-rounded workout routine: To help give our legs a break from high-impact activities you can ncorporate low-impact exercises like cycling or swimming into your routine.
Continue strengthening and stretching: Regularly strengthening the muscles in your legs and stretching your calves and Achilles tendons can reduce stress on your shins.
Cross-train: Mix up your workouts with different types of exercise to avoid overloading your shins with repetitive impact.
Shin Splints Don't Have to Hold You Back
Shin splints can definitely be painful and frustrating especially if you're in the middle of training, but with the right treatment and preventative strategies, you can recover and get back to your favorite activities. Remember, rest is key to healing, and making gradual changes, instead of sudden, to your workout routine can help you avoid shin splints in the future. If your symptoms persist, don't hesitate to seek help from a sports medicine specialist, who can provide a tailored treatment plan to get you back on track.
This blog post is meant to be informative and should not act as a self-diagnosis tool. If you’d like to see one of our doctors, please contact us here.
