Biomechanical characteristics of foot disease in chronic gout

NewsBot · Oct 19, 2010

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Functional and biomechanical characteristics of foot disease in chronic gout: A case-control study.
Clin Biomech (Bristol, Avon). 2010 Oct 13. [Epub ahead of print]
Rome K, Survepalli D, Sanders A, Lobo M, McQueen FM, McNair P, Dalbeth N.

OBJECTIVES: Despite the predilection of gout to the feet, the impact of gout on foot function and biomechanics is currently unknown. The aim of this study was to describe the effects of chronic gout upon function and selected biomechanical parameters associated with gait.

METHODS: Twenty-five patients with a history of gout were compared with 25 age and gender matched control participants with no history of gout or other forms of arthritis. General function, foot specific disease activity and lower limb activities were determined using the Health Assessment Questionnaire, Foot Function Index (pain domain), and Leeds Foot Impact Scale respectively. Each patient also underwent a gait assessment that included plantar pressure measurements and an evaluation of temporal-spatial gait parameters.

FINDINGS: Patients with chronic gout had higher levels of general and foot-specific disability, pain and impairment (P≤0.001). Significantly lower peak plantar pressures were observed in the hallux of patients with chronic gout (P≤0.05). Significantly higher pressure-time integrals were observed in the cases at the midfoot (P≤0.05), but lower values were observed at the hallux (P≤0.05). Patients with chronic gout walked slower, with longer step and stride lengths compared to the controls.

INTERPRETATION: Patients with chronic gout experience pain and disability associated with their feet. Different toe-off strategies may account for functional changes and pain associated with foot problems in chronic gout.
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Admin2 · Oct 19, 2010

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NewsBot · Jun 19, 2017

Clinically-evident tophi are associated with reduced muscle force in the foot and ankle in people with gout: a cross-sectional study
Sarah Stewart, Nicola Dalbeth, Simon Otter, Peter Gow, Sunil Kumar and Keith Rome
Journal of Foot and Ankle Research201710:25

Background
The foot and ankle represent a common site for tophi in people with gout, yet it is unclear whether the presence of tophi is related to impaired muscle function. This study aimed to determine the association between foot and ankle tophi and muscle force in people with gout.

Methods
Participants with gout were stratified into two groups based on the presence of clinically-evident tophi affecting the foot or ankle on physical examination. Isometric muscle force for plantarflexion, dorsiflexion, inversion and eversion was measured using static dynamometry. Mixed-models regression was used to determine the difference in muscle force between the two groups while adjusting for age, disease duration and foot pain. This model was also used to determine the difference in muscle force between presence and absence of tophi at specific locations within the foot and ankle. In addition, Pearson’s correlations were used to determine the association between total foot tophus count and muscle force.

Results
Fifty-seven participants were included (22 with foot or ankle tophi and 35 without foot or ankle tophi). Foot and ankle tophi were most often seen at the Achilles tendon. After adjusting for age, disease duration and foot pain, participants with tophi had significantly reduced muscle force during plantarflexion (P < 0.001), dorsiflexion (P = 0.003), inversion (P = 0.003) and eversion (P = 0.001) when compared to participants without tophi. Those with Achilles tophi had significantly reduced force during plantarflexion (P < 0.001), inversion (P = 0.008) and eversion (P = 0.001). No significant differences in muscle force were observed between the presence and absence of tophi at other foot or ankle locations. There were also no significant correlations between total foot tophus count and muscle force (all P > 0.05).

Conclusion
In people with gout, clinically-evident foot or ankle tophi are associated with muscle force deficits during foot plantarflexion, dorsiflexion, inversion and eversion, which persist despite adjusting for age, disease duration and foot pain. Tophi at the Achilles tendon, which associate with force deficits, may contribute to reduced muscular activation and consequent disuse muscle atrophy.
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NewsBot · Apr 18, 2018

Ankle joint function during walking in tophaceous gout: a biomechanical gait analysis study
Matthew Carroll et al
Gait and Posture; in press

Highlights
•First study to assess ankle joint function in people with tophaceous gout.
•Ankle joint function does not change in people with gout.
•People with gout have decreased ankle joint angular velocity.
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Background
The foot and ankle are frequently affected in tophaceous gout, yet kinematic and kinetic changes in this region during gait are unknown. The aim of the study was to evaluate ankle biomechanical characteristics in people with tophaceous gout using three-dimensional gait analysis.

Methods
Twenty-four participants with tophaceous gout were compared with 24 age-and sex-matched control participants. A 9-camera motion analysis system and two floor-mounted force plates were used to calculate kinematic and kinetic parameters.

Results
Peak ankle joint angular velocity was significantly decreased in participants with gout (P < 0.01). No differences were found for ankle ROM in either the sagittal (P = 0.43) or frontal planes (P = 0.08). No differences were observed between groups for peak ankle joint power (P = 0.41), peak ankle joint force (P = 0.25), peak ankle joint moment (P = 0.16), timing for peak ankle joint force (P = 0.81), or timing for peak ankle joint moment (P = 0.16).

Conclusions
Three dimensional gait analysis demonstrated that ankle joint function does not change in people with gout. People with gout demonstrated a reduced peak ankle joint angular velocity which may reflect gait-limiting factors and adaptations from the high levels of foot pain, impairment and disability experienced by this population.
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NewsBot · Jan 28, 2019

Foot structure, pain and functional ability in people with gout in primary care: cross-sectional findings from the Clinical Assessment Study of the Foot
Helen R. Petty, Trishna Rathod-Mistrye, Hylton B. Menz and Edward Roddy
Journal of Foot and Ankle Research201912:8

Background
Gout frequently affects the foot yet relatively little is known about the effects of gout on foot structure, pain and functional ability. This study aimed to describe the impact of gout in a UK primary care population.

Methods
A cross-sectional study was nested within an observational cohort study of adults aged ≥50 years with foot pain. Participants with gout were identified through their primary care medical records and each matched on age (±2 years) and gender to four participants without gout. Differences in person-level variables (SF-12 Physical Component Score, Manchester Foot Pain and Disability Index and Short Physical Performance Battery) between gout and non-gout participants were determined using regression models. Differences in foot-level variables (pain regions, skin lesions, deformities, foot posture, and non-weightbearing range of motion) were determined using multi-level regression models. All models were adjusted for body mass index. Means and probabilities with 95% confidence intervals were calculated.

Results
Twenty-six participants with gout were compared to 102 participants without gout (77% male; mean age 66 years, standard deviation 11). Subtalar joint inversion and eversion and 1st metatarsophalangeal joint (MTPJ) dorsiflexion range of motion were significantly lower in the gout participants compared to the non-gout participants. Gout participants were more likely to have mallet toes and less likely to have claw toes compared to non-gout participants. There were no statistically significant differences in person-level variables, foot posture, ankle dorsiflexion range of motion, hallux valgus, pain regions, or skin lesions.

Conclusions
Non-weightbearing range of motion at the subtalar joint and 1st MTPJ was reduced in people with gout. Patients with gout who present with chronic foot problems should therefore undergo appropriate clinical assessment of foot structure.
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