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Monday, October 19, 2009: 9:00 AM - 11:00 AM
Hall D (Pennsylvania Convention Center)
Presentation Number: 1119
Poster Board Number: 470
Purpose: Despite the predilection of gout to the foot, the impact of this disease on foot function is currently unknown. The aim of this case-control study was to analyse the impact of chronic gout on foot function and measures of foot disability.
Method: Cases with gout (n=25) were recruited from rheumatology outpatient clinics. All cases had a history of acute gout according to ACR diagnostic criteria (median disease duration 21 years, flare frequency 2.92/year, 44% with tophi). Cases were excluded if they were experiencing an acute gout flare at the time of assessment, had lower limb amputation or diabetes mellitus. Age, sex and BMI-matched control participants (n=25) without arthritis, lower limb amputation or diabetes mellitus were also analysed. Plantar pressures were recorded using an in-shoe system to determine peak pressure and pressure-time integrals under ten regions of the foot. An instrumented walkway was used to capture spatial and temporal gait parameters. Disease impact was measured using the Leeds Foot Impact Scale. To preserve data independence, data from the right foot of each participant were analysed.
Results: Significant differences in all foot measures were observed between cases and controls (Table). In particular, significant differences were present in the pressure-time integrals across all foot regions except under the hallux and lesser toes, with higher pressures over time in the gout group. Gait parameters that included walking speed, cadence and double-support were also impaired in cases with gout. Patient reported scores of disease impact were significantly higher in the cases.
Conclusion: Chronic gout is associated with important changes in load-bearing function across the entire foot, which may contribute to the development of pain and disability in this disease.
Method: Cases with gout (n=25) were recruited from rheumatology outpatient clinics. All cases had a history of acute gout according to ACR diagnostic criteria (median disease duration 21 years, flare frequency 2.92/year, 44% with tophi). Cases were excluded if they were experiencing an acute gout flare at the time of assessment, had lower limb amputation or diabetes mellitus. Age, sex and BMI-matched control participants (n=25) without arthritis, lower limb amputation or diabetes mellitus were also analysed. Plantar pressures were recorded using an in-shoe system to determine peak pressure and pressure-time integrals under ten regions of the foot. An instrumented walkway was used to capture spatial and temporal gait parameters. Disease impact was measured using the Leeds Foot Impact Scale. To preserve data independence, data from the right foot of each participant were analysed.
Results: Significant differences in all foot measures were observed between cases and controls (Table). In particular, significant differences were present in the pressure-time integrals across all foot regions except under the hallux and lesser toes, with higher pressures over time in the gout group. Gait parameters that included walking speed, cadence and double-support were also impaired in cases with gout. Patient reported scores of disease impact were significantly higher in the cases.
Conclusion: Chronic gout is associated with important changes in load-bearing function across the entire foot, which may contribute to the development of pain and disability in this disease.
Table: Foot function measures (median, IQR)
Variable | Control Group | Gout Group | P |
| Peak Pressures (kPa) | |||
| Medial Heel | 276 (230-362) | 259 (190-316) | 0.59 |
| Lateral Heel | 261 (205-317) | 253 (180-292) | 0.07 |
| Midfoot | 101 (85-117) | 140 (99-189) | <0.01 |
| Hallux | 264 (142-326) | 129 (74-224) | <0.01 |
| 2-5th Toes | 176 (137-256) | 130 (87-174) | <0.01 |
| 1 Metatarsophangeal Joint (MTPJ) | 228 (176-314) | 201 (128-284) | 0.28 |
| 2 MTPJ | 247 (195-315) | 352 (172-389) | 0.30 |
| 3 MTPJ | 281 (205-341) | 347 (178-431) | 0.25 |
| 4 MTPJ | 195 (174-392) | 260 (154-321) | 0.77 |
| 5 MTPJ | 168 (117-300) | 168 (137-253) | 0.09 |
| Pressure-Time Integrals (kPa.sec) | |||
| Medial Heel | 61 (46-72) | 74 (65-78) | <0.01 |
| Lateral Heel | 61 (49-69) | 71 (67-91) | <0.01 |
| Midfoot | 68 (58-79) | 80 (67-91) | 0.02 |
| Hallux | 56 (46-66) | 59 (42-70) | 0.09 |
| 2-5th Toes | 61 (48-67) | 66 (43-81) | 0.23 |
| 1 MTPJ | 74 (63-86) | 78 (66-92) | 0.01 |
| 2 MTPJ | 74 (60-84) | 78 (68-93) | 0.04 |
| 3 MTPJ | 76 (63-86) | 80 (71-90) | 0.03 |
| 4 MTPJ | 84 (71-95) | 84 (71-95) | 0.05 |
| 5 MTPJ | 80 (72-92) | 80 (72-92) | 0.03 |
| Spatial and Temporal Gait Parameters | |||
| Walking Speed (m/s) | 1.1 (0.9-1.3) | 0.9 (0.8-1.1) | <0.01 |
| Cadence (steps/min) | 104 (96-114) | 95 (91-102) | <0.01 |
| Double Support (s) | 0.16 (0.13-0.18) | 0.19 (0.16-0.22) | <0.01 |
| Impairment/ footwear | 0 (0-2) | 10 (5-15) | <0.01 |
| Activity limitation/participation restriction | 0 (0-0) | 17 (5-25) | <0.01 |
Keywords: foot disorders and gout
Disclosure: K. Rome, None; D. Survepalli, None; A. Sanders, None; M. Lobo, None; F. M. McQueen, None; P. McNair, None; N. Dalbeth, None.