I’m having a bad gout attack. My doctor wants to use a needle to draw fluid out of my big toe. But the toe is so puffed up and swollen, I don’t see how he can even find the joint. Is it really safe to try?

Physicians are trained in specific techniques such as aspiration and injection of gouty toes. Aspiration refers to drawing fluid out of a joint or space.

Knowledge of the anatomy is required. When swelling covers the surface, the normal, uninvolved foot can be used as a guide. The doctor palpates (feels) the surface of the normal side and compares it to the swollen toe.

A slight downward pull on the toe can help option up the joint space. Using just the right angle, the needle is inserted and advanced carefully into the joint. The physician is careful to avoid local nerves, blood vessels, and tendons.

Sometimes a bone spur gets in the way and the needle must be pulled out a little. Then it is reinserted using a slightly different angle. The physician is prepared for such events. In the hands of a trained and experienced clinician, this procedure is both safe and effective.