Why is Gout Often in the Big Toe?

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There are many studies that would verify that the big toe is the most common target for gout attacks. For one, a certain study analyzed 516 cases of gout and found that 73% of the first attacks occur in the big toe, either in the right or left, or both toes at the same time. Even before the turn of the century, medical practitioners knew the highly observed phenomenon with the big toe pain as a recurrent symptom of gout.

Another review study agrees with the above findings. A review of various journals and publications for more than 150 years also revealed that the big toe remains as the favorite first attack target at 60% to 65% of all the gout cases. Furthermore, it was also observed that when the first attack happened outside the big toe, the probability that the subsequent attack will happen in the big toe is also high. With such findings, there could be a possible explanation why is gout often in the big toe.

Why Does this Happen to the Big Toe?

Why is gout often in the big toe? This could not be just coincidence because it happens too frequently.

Gout is characterized by pain due to the abnormally high levels of uric acid in the body. When the levels of uric acid in the blood are high, it has the tendency to crystallize. The standard followed by modern medicine as the critical level, where crystallization of uric acid is highly probably, is 7.0 mg/dL for men and 6.5 mg/dL for women.

But aside from the levels of the uric acid in the bloodstream, there are other factors that may trigger the crystallization of uric acid. Temperature is one of these triggers. Cold weather can promote gout attacks. In this connection, the colder parts of the body, where blood flow may be slower, can be most affected. In colder parts of the body, uric acid can crystallize faster as monosodium urate crystals or more commonly known as the gout crystals.

The big toes are considered as one of the coldest parts of the body where blood circulation is at its slowest. This is also true with other extremities like the fingers.

Big Toe Gout as a Sign

Acknowledging this sign may help one prevent recurrent gout flare ups. The occurrence of big toe gout is usually preceded with prickling sensations and twinges within the big toe. This can be an indicator of abnormally high levels of uric acid in the body. Therefore, it is an early warning that one should be aware of.

How to Prevent Big Toe Gout

To prevent big toe gout, warmth and exercise are very essential. It has to be noted that there are no drugs that can reduce the uric acid level in the toes. One needs to eliminate the triggers that can lead to the occurrence of big toe gout.

During cold seasons, it is recommended that one must dress warmly particularly in the feet. In addition, it is strongly advised to wear gloves for the fingers as this part can also be affected.

Remedy for Big Toe Gout

A 2009 study from Taiwan the possible remedy of using arthroscope to examine and remove the gout crystals in the big toe or metatarsophalangeal joint. The researchers discovered that these gout patients who underwent the arthroscopy procedure had fewer recurrent attacks compared to those on medications. The conclusion suggested that removing the crystals is very critical before the numbers grow for recurrent gout attacks.


Why is gout often in the big toe? This information explained the answer to that question. This is because the extremities are often the coldest part of the body and blood circulation is at its slowest in these parts. Improper blood circulation promotes uric acid crystallization. As a remedy, warmth and exercise are strongly encouraged to promote blood flow and discourage the crystallization of uric acid. Furthermore, the method using arthroscopy to remove gout crystals in the big toe is also recommended, as advised by one Taiwanese study.


Emmerson, Brian M.D., PhD., The Management of Gout, Massachusetts Medical Society 1996.

Sands, Jeff DDS, The Ultimate Gout Relief Report