I ve never had it in my toe, so that misled me for a while, she says. Usually, the pain is limited to the first joint of the big toe, other joints in the foot, the knee and sometimes the wrist and elbow. The pain occurs when sharp crystals of uric acid form in the fluid surrounding a joint. That happens when blood levels of uric acid become too high or, paradoxically, drop too quickly. Alcohol, rich foods, drugs that reduce blood pressure, lead poisoning, even inherited metabolic disorders can cause gout.
Uric acid can also crystallize in the kidneys and other soft tissues, causing damage.
So staving off attacks is important for reasons that go beyond pain prevention. A gout attack often starts at night, as a joint becomes increasingly hot, swollen and painful. It can come on fast, George says. It usually doesn t wake me up at night, but I can go to bed fine and wake up in the morning with a stiff, swollen ankle. George knows that if she sticks with low-fat vegetarian fare, her symptoms will subside.