What to do during a gout attack

During an acute gout attack, your goal is to reduce pain and swelling as quickly as possible. Start by resting the affected foot and keeping it elevated above heart level—this slows blood flow to the joint and can ease discomfort. Apply ice wrapped in a cloth for 20 minutes at a time, several times a day, but do not place ice directly on skin.

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, or indomethacin work well if you start them early in the attack. Take them at the dose on the package and continue for a few days even after pain improves, since stopping too soon can trigger the attack to flare again. If NSAIDs upset your stomach or you cannot take them due to other health conditions, ask your doctor about colchicine, a prescription medication that reduces inflammation specifically in gout attacks.

Avoid putting weight on the foot if possible. Even a bedsheet touching the joint can cause pain, so some people find relief by creating a tent over the foot with pillows. Most attacks peak within 24 to 48 hours and improve over one to two weeks with treatment.

Key Takeaways

  • NSAIDs like ibuprofen or naproxen are the first-line treatment during an attack and work best if started within the first 24 hours.
  • Prescription colchicine or corticosteroids are alternatives if NSAIDs do not work or you cannot take them.
  • Long-term medications like allopurinol or febuxostat lower uric acid levels and prevent future attacks, but do not treat the current one.
  • Dietary changes—limiting red meat, organ meats, high-fructose corn syrup, and alcohol—reduce attack frequency over time.
  • Your doctor can prescribe preventive medication before you start uric acid-lowering therapy to avoid triggering new attacks.

When to see a doctor about gout in your foot

See a doctor if this is your first suspected gout attack, since other conditions like infection or rheumatoid arthritis can feel similar. A doctor can examine the joint, order blood tests to measure uric acid levels, and sometimes perform a joint fluid test to confirm gout crystals are present. This confirmation matters because the treatment approach changes if the diagnosis is different.

Also contact your doctor if attacks happen more than once or twice a year, if the pain does not improve within a week of treatment, or if you develop gout in multiple joints. These patterns suggest you need long-term uric acid management, not just acute treatment. If you have kidney disease, heart disease, or take certain medications like diuretics, mention this when discussing gout—these conditions affect which treatments are safe for you.

Medications that prevent future attacks

Uric acid-lowering drugs reduce the amount of uric acid your body produces or help your kidneys excrete more of it. Allopurinol is the most commonly prescribed; it blocks the enzyme that converts purines to uric acid. Febuxostat works similarly but may be an option if allopurinol causes side effects. These medications take weeks to months to lower uric acid enough to prevent attacks, so they do not help during an active flare.

Starting uric acid-lowering therapy can actually trigger new attacks in the first few weeks as crystals break down and move through the joint. To prevent this, doctors often prescribe a low dose of colchicine or an NSAID to take daily for the first three to six months while uric acid levels drop. Once your uric acid is stable and below the target level (usually below 6 mg/dL), attack frequency drops significantly.

Pegloticase is a newer option for people whose uric acid remains high despite allopurinol or febuxostat. It is given as an infusion and breaks down uric acid directly, but it is expensive and reserved for severe, recurrent gout.

Dietary and lifestyle changes that reduce attacks

Certain foods and drinks trigger gout attacks by raising uric acid levels. Red meat, organ meats (liver, kidney, brain), and shellfish are high in purines, which your body converts to uric acid. High-fructose corn syrup and regular soda also increase uric acid; diet sodas do not. Alcohol, especially beer, raises uric acid and dehydrates you, which concentrates uric acid in your blood—limiting alcohol to one or two drinks per day or less reduces attack risk.

Staying hydrated helps your kidneys flush uric acid. Aim for enough water that your urine is pale yellow rather than dark. Weight loss, if you are overweight, also lowers uric acid levels and reduces attack frequency. Moderate exercise does not trigger attacks and may help over time.

Vitamin C from food (citrus, berries, peppers) may lower uric acid slightly, and some research suggests coffee drinkers have fewer attacks, though the effect is modest. These dietary changes work alongside medication, not instead of it—they reduce attack frequency but do not replace uric acid-lowering drugs for people with recurrent gout.

What happens if you do not treat gout

Untreated gout attacks become more frequent and last longer. Over years, repeated attacks can damage the joint permanently, causing chronic pain and reduced movement even between flares. Uric acid crystals can also deposit in soft tissues around the joint, forming lumps called tophi that may eventually require surgery.

High uric acid levels also increase risk of kidney stones and may contribute to kidney disease over time. If you have had more than one or two attacks, starting long-term uric acid-lowering medication prevents these complications and usually stops attacks altogether once uric acid is controlled.

Managing gout alongside other health conditions

Gout treatment becomes more complicated if you have kidney disease, heart failure, or high blood pressure. NSAIDs can worsen kidney function and raise blood pressure, so your doctor may recommend colchicine or corticosteroids instead. Diuretics (water pills) used for heart failure or high blood pressure can raise uric acid and trigger gout—your doctor may switch you to a different medication if gout becomes a problem.

If you take aspirin for heart disease, low-dose aspirin does not usually affect gout, but higher doses can raise uric acid. Tell your doctor about all your medications and conditions so they can choose gout treatments that do not interfere with your other care. Sometimes managing one condition well (like losing weight or controlling blood pressure) also improves gout.

Frequently Asked Questions

How long does a gout attack last?

Most attacks peak within 24 to 48 hours and improve over one to two weeks with treatment. Without treatment, attacks can last three to four weeks. Starting NSAIDs or colchicine early shortens the duration significantly.

Can you get gout in your foot if you have never had it before?

Yes. First attacks often happen suddenly and without warning, sometimes after eating a large meal high in purines, drinking alcohol, or starting a new medication. Some people have one attack and never have another; others develop recurrent gout.

Is gout the same as arthritis?

Gout is a type of arthritis caused by uric acid crystals in the joint. Other types of arthritis, like osteoarthritis or rheumatoid arthritis, have different causes and treatments. A doctor can tell the difference through blood tests and sometimes joint fluid analysis.

Will losing weight help gout?

Yes. Weight loss lowers uric acid levels and reduces attack frequency. Losing even 5 to 10 percent of your body weight can make a difference. Avoid crash diets, though—rapid weight loss can temporarily raise uric acid and trigger attacks.

Can you prevent gout attacks completely?

Long-term uric acid-lowering medication prevents most attacks once uric acid is controlled. Dietary changes and staying hydrated reduce attack risk further. Most people on medication have few or no attacks, though some still experience occasional flares.