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Yadav S, Khandelwal N, Nath SK, Rai S. A Hospital-Based Cross-Sectional Study of Patients With Plantar Fasciitis: Is Hyperuricemia Screening Needed? Cureus 2023; 15:e37088. [PMID: 37153317 PMCID: PMC10157332 DOI: 10.7759/cureus.37088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
Background and aim Generally, asymptomatic hyperuricemia is considered a benign metabolic abnormality with little clinical significance in the absence of gout or renal calculus. However, its clinical association with plantar fasciitis is still not known and is a subject of interest. The study aims to investigate the association between asymptomatic hyperuricemia and plantar fasciitis in otherwise healthy patients. Materials and methods A cross-sectional study was performed, which included 284 patients aged 21-65 years with plantar fasciitis and without any comorbidities between February 2020 and November 2022. One hundred and fifty patients with hyperuricemia who attended the endocrinology and medicine outpatient department without heel pain were included as a control group. Serum uric acid levels were assessed in all cases. Student's t-test, correlation tests, and multiple linear regression were used to ascertain the association between uric acid levels and plantar fasciitis. Statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 19.0 (Released 2010; IBM Corp., Armonk, New York, United States). Results Among the 284 patients, 189 were female (66.5%) and 95 were male (33.4%). Their mean age was 43 ± 9 years (range: 21-65 years). The p-values of the duration of symptoms, visual analog scale for pain (VAS), and foot function index (FFI) total score were p = 0.061, p = 0.068, and p < 0.001, respectively. The mean uric acid levels were 7.6 ± 1.5 mg/dL in males and 7.3 ± 1.3 mg/dL in females in the sample group, and 8.3 ± 1.8 mg/dL in males and 8.1 ± 1.5 mg/dL in females in the control group. According to a Pearson correlation analysis, there was no correlation between serum uric acid level and BMI, VAS, duration of symptoms, FFI pain, disability sub-scores, or FFI total score. Conclusion Although asymptomatic hyperuricemia is a common metabolic abnormality, the present study did not find any significant association between it and plantar fasciitis. Therefore, we can conclude that routine screening for asymptomatic hyperuricemia is not recommended in plantar fasciitis. Evidence level: II.
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Nguyen V, Brenton-Rule A, Dalbeth N, Rome K, Stewart S. An evaluation of podiatry service use for people with inflammatory rheumatic diseases: a review of a rheumatology podiatry clinic in Aotearoa New Zealand. J Foot Ankle Res 2022; 15:36. [PMID: 35578311 PMCID: PMC9108704 DOI: 10.1186/s13047-022-00542-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/29/2022] [Indexed: 11/12/2022] Open
Abstract
Background Foot problems, including foot pain, structural deformities, skin and nail lesions, and footwear difficulties, are common in people with inflammatory rheumatic diseases. However, dedicated podiatry services are limited, including in Aotearoa New Zealand. This study aimed to evaluate the podiatry service use for people with inflammatory rheumatic diseases who attended a specialist podiatric rheumatology clinic in Aotearoa New Zealand. Methods This retrospective review included people with an inflammatory rheumatic disease who attended the Auckland University of Technology Podiatric Rheumatology Clinic between 2010 and 2021. Data were extracted manually from patients’ clinical records, including variables relating to patient characteristics, appointment details, presenting complaint, assessments performed, and treatments provided. Results From 2010 to 2021, 157 people with inflammatory rheumatic diseases attended 1570 appointments. The most common presenting concern was foot pain (reported by n = 121, 77.1% patients during at least one appointment), followed by skin/nail lesions (n = 98, 62.4%) and footwear/orthotic needs (n = 90, 57.3%). A range of podiatric interventions were provided to address foot-care needs, in which education (n = 151, 96.2%) and general skin/nail care (n = 107, 68.2%) were the most common treatments provided. The majority of patients also received footwear interventions at some point during their period of service provision (n = 96, 61.1%), followed by orthoses, other padding/offloading devices, wound care, exercise prescription and referrals to other health professionals. Conclusions This is the first study to review podiatric service provision for people with inflammatory rheumatic diseases attending a specialist podiatric rheumatology clinic in Aotearoa New Zealand. The results of this study have shown that a podiatry clinic dedicated to people with inflammatory rheumatic diseases addresses the wide range of foot problems through an extensive provision of treatment services. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00542-7.
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Wireless, battery-free and wearable device for electrically controlled drug delivery: sodium salicylate released from bilayer polypyrrole by near-field communication on smartphone. Biomed Microdevices 2020; 22:53. [DOI: 10.1007/s10544-020-00511-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Jonsson H, Aspelund T, Eiriksdottir G, Harris TB, Launer LJ, Gudnason V. Hyperuricemia is associated with intermittent hand joint pain in a cross sectional study of elderly females: The AGES-Reykjavik Study. PLoS One 2019; 14:e0221474. [PMID: 31442261 PMCID: PMC6707588 DOI: 10.1371/journal.pone.0221474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 08/07/2019] [Indexed: 11/18/2022] Open
Abstract
Background The debate whether "asymptomatic hyperuricemia" should be treated is still ongoing. The objective of this cross-sectional study was to analyze whether hyperuricema in the elderly is associated with joint pain. Methods and findings Participants in the population-based AGES-Reykjavik Study (males 2195, females 2975, mean age 76(6)) answered standardized questions about joint pain. In addition they recorded intermittent hand joint pain by marking a diagram of the hand. In males, no association was found between hyperuricemia and pain. Females however, showed a positive association between hyperuricemia and joint pain at many sites. After adjustment for age, BMI and hand osteoarthritis however, only intermittent hand joint pain (OR 1.30(1.07–1.58), p = 0.008) and intermittent pain in ≥10 hand joints (OR 1.75(1.32–2.31), p<0.001) remained significant. The best model for describing the relationship between serum uric acid levels (SUA) and intermittent hand joint pain in ≥10 joints was non-linear with a cut-off at 372 μmol/L. The attributable surplus number of symptomatic females with SUA ≥372 μmol/L was approximately 2.0% of the study population for those reporting pain in ≥10 hand joints. Next after having severe hand osteoarthritis, SUA ≥372 was an independent predictive factor of intermittent pain in ≥10 hand joints. Intermittent hand joint pain was also an independent risk factor for worse general health description. Conclusion Results from this population based study indicate that hyperuricemia in elderly females may be a rather frequent cause of intermittent hand joint pain, often in many joints. The most likely explanation relates to low-grade urate crystal induced inflammation. Our data do not allow for assessment of the severity of symptoms or whether they merit specific treatment, but intermittent hand joint pain was an independent predictor of worse general health. These findings may be an important contribution to the debate on whether hyperuricemia should be treated.
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Affiliation(s)
- Helgi Jonsson
- Landspitalinn University Hospital, Reykjavík, Iceland
- University of Iceland, Reykjavik, Iceland
- * E-mail:
| | - Thor Aspelund
- University of Iceland, Reykjavik, Iceland
- Icelandic Heart Association, Kopavogur, Iceland
| | | | - Tamara B. Harris
- National Institute on Aging, Bethesda, MD, United States of America
| | - Lenore J. Launer
- National Institute on Aging, Bethesda, MD, United States of America
| | - Vilmundur Gudnason
- University of Iceland, Reykjavik, Iceland
- Icelandic Heart Association, Kopavogur, Iceland
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5
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Alammari YM, Gheta D, Flood RM, Boran G, Kane DJ, Mullan RH. Urate-lowering therapy (ULT) reduces non-episodic foot pain in patients who fail to meet ACR/EULAR 2015 gout classification criteria: an effect predicted by ultrasound and potential rationale for reclassification. Ann Rheum Dis 2019; 78:579-580. [PMID: 30373883 DOI: 10.1136/annrheumdis-2018-214305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/26/2018] [Accepted: 10/08/2018] [Indexed: 12/27/2022]
Affiliation(s)
| | - Diana Gheta
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | - Rachael Mary Flood
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | - Gerard Boran
- Department of Clinical Chemistry, Tallaght University Hospital, Dublin, Ireland
| | - David J Kane
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | - Ronan Hugh Mullan
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
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Petty HR, Rathod-Mistry T, Menz HB, Roddy E. Foot structure, pain and functional ability in people with gout in primary care: cross-sectional findings from the Clinical Assessment Study of the Foot. J Foot Ankle Res 2019; 12:8. [PMID: 30700995 PMCID: PMC6347747 DOI: 10.1186/s13047-019-0317-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/15/2019] [Indexed: 11/17/2022] Open
Abstract
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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Affiliation(s)
- Helen R Petty
- 1Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, and Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, ST5 5BG UK
| | - Trishna Rathod-Mistry
- 1Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, and Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, ST5 5BG UK
| | - Hylton B Menz
- 1Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, and Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, ST5 5BG UK.,2School of Allied Health, La Trobe University, Bundoora, Victoria 3086 Australia
| | - Edward Roddy
- 1Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, and Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, ST5 5BG UK.,3Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent Partnership NHS Trust, Haywood Hospital, Burslem, Staffordshire UK
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Blandin C, Forien M, Gardette A, Palazzo E, Dieudé P, Ottaviani S. Tophus size is associated with hallux valgus deformity in gout. Eur J Clin Invest 2018; 48. [PMID: 29171878 DOI: 10.1111/eci.12862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/19/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Hallux valgus (HV) and gout are common pathologies of the first metatarsophalangeal joint (MTP1) leading to pain and deformation. In this study, we aimed to determine the correlation between tophus size and characteristics of HV in gouty patients. METHODS In this case-control study, we included patients with gout (the presence of monosodium urate crystals in synovial fluid) and control patients with spondyloarthritis, without crystal disease disorders. Radiographic assessment and ultrasound (US) assessment were performed by two blinded operators. US features of gout (double contour [DC] sign and/or tophus) were collected. HV was defined by hallux abductus (HA) angle ≥20° and/or intermetatarsal angle (IM) ≥10°. Correlation between US findings and HV angles was estimated by Spearman correlation coefficient. RESULTS We included 56 gouty patients (87.5% males, mean age of 63.9 ± 12.2 years) and 41 control patients (90% males, mean age of 59.0 ± 12.8 years). HV was more frequent in patients with gout than controls (62% vs 37%, P = .0007). Regardless of HV status, correlations were found between the size of US tophi and IM (r = .3381, P = .003) and HA angles (r = .2344, P = .043). CONCLUSIONS Our results confirm a high prevalence of HV in gouty patients. We also observed a correlation between the size of the US tophus and the angles defining HV, which suggests a link between urate deposition load and HV. Early urate-lowering therapy for gout could limit the occurrence of HV.
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Affiliation(s)
- Camille Blandin
- Sorbonne Paris Cité, UFR de Médecine, Université Paris Diderot, Paris, France.,AP-HP, Service de Rhumatologie, Hôpital Bichat, Paris, France
| | - Marine Forien
- Sorbonne Paris Cité, UFR de Médecine, Université Paris Diderot, Paris, France.,AP-HP, Service de Rhumatologie, Hôpital Bichat, Paris, France
| | - Anais Gardette
- Sorbonne Paris Cité, UFR de Médecine, Université Paris Diderot, Paris, France.,AP-HP, Service de Rhumatologie, Hôpital Bichat, Paris, France
| | - Elisabeth Palazzo
- Sorbonne Paris Cité, UFR de Médecine, Université Paris Diderot, Paris, France.,AP-HP, Service de Rhumatologie, Hôpital Bichat, Paris, France
| | - Philippe Dieudé
- Sorbonne Paris Cité, UFR de Médecine, Université Paris Diderot, Paris, France.,AP-HP, Service de Rhumatologie, Hôpital Bichat, Paris, France
| | - Sébastien Ottaviani
- Sorbonne Paris Cité, UFR de Médecine, Université Paris Diderot, Paris, France.,AP-HP, Service de Rhumatologie, Hôpital Bichat, Paris, France
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Stewart S, Dalbeth N, Otter S, Gow P, Kumar S, Rome K. Clinically-evident tophi are associated with reduced muscle force in the foot and ankle in people with gout: a cross-sectional study. J Foot Ankle Res 2017. [PMID: 28649283 PMCID: PMC5477352 DOI: 10.1186/s13047-017-0207-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
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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Affiliation(s)
- Sarah Stewart
- Department of Podiatry, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand
| | - Nicola Dalbeth
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand.,Department of Rheumatology, Auckland District Health Board, P.O. Box 92189, Auckland, New Zealand
| | - Simon Otter
- School of Health Sciences, University of Brighton, 49 Darley Road, Eastbournem, Brighton BN20 7UR UK
| | - Peter Gow
- Department of Rheumatology, Counties Manukau District Health Board, Auckland, New Zealand
| | - Sunil Kumar
- Department of Rheumatology, Counties Manukau District Health Board, Auckland, New Zealand
| | - Keith Rome
- Department of Podiatry, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand
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Stewart S, Dalbeth N, Vandal AC, Allen B, Miranda R, Rome K. Are ultrasound features at the first metatarsophalangeal joint associated with clinically-assessed pain and function? A study of people with gout, asymptomatic hyperuricaemia and normouricaemia. J Foot Ankle Res 2017; 10:22. [PMID: 28539973 PMCID: PMC5441079 DOI: 10.1186/s13047-017-0203-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/15/2017] [Indexed: 01/05/2023] Open
Abstract
Background The first metatatarsophalangeal joint (1st MTP joint) is a common location for sonographic evidence of urate deposition in people with gout and asymptomatic hyperuricaemia. However, it is unclear whether these are related to clinically-assessed pain and function. This study aimed to determine the association between ultrasound features and clinical characteristics of the 1st MTP joint in people with gout, asymptomatic hyperuricaemia and age- and sex-matched normouricaemic individuals. Methods Twenty-three people with gout, 29 with asymptomatic hyperuricaemia and 34 with normouricaemia participated in a cross-sectional study. No participant had clinical evidence of acute inflammatory arthritis at the time of assessment. Four sonographic features at the 1st MTP joint were analysed: double contour sign, tophus, bone erosion and synovitis. Clinical characteristics included in the analysis were 1st MTP joint pain, overall foot pain and disability, 1st MTP joint temperature, 1st MTP joint range of motion and gait velocity. Statistical analyses adjusted for the diagnostic group of the participant. Results After accounting for the diagnostic group, double contour sign was associated with higher foot pain and disability scores (P < 0.001). Ultrasound tophus was associated with higher foot pain and disability scores (P < 0.001), increased temperature (P = 0.005), and reduced walking velocity (P = 0.001). No associations were observed between ultrasound synovitis or erosion and the clinical characteristics. Conclusions Ultrasound features of urate crystal deposition, rather than soft tissue inflammation or bone erosion, are associated with clinical measures of foot-related functional impairment and disability even in the absence of clinical evidence of current acute inflammatory arthritis. This association persisted regardless of the diagnosis of the participant as having gout or asymptomatic hyperuricaemia.
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Affiliation(s)
- Sarah Stewart
- Department of Podiatry, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand
| | - Nicola Dalbeth
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand.,Department of Rheumatology, Auckland District Health Board, P.O. Box 92189, Auckland, New Zealand
| | - Alain C Vandal
- Department of Biostatistics & Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand.,Health Intelligence & Informatics, Ko Awatea, Counties Manukau Health, Private Bag 93311, Auckland, 1640 New Zealand
| | - Bruce Allen
- Horizon Radiology, Auckland University of Technology North Shore Campus, AA Building, 90 Akoranga Drive, Northcote, Auckland, New Zealand
| | - Rhian Miranda
- Auckland City Hospital Radiology, Auckland District Health Board, P.O Box 92189, Auckland, New Zealand
| | - Keith Rome
- Department of Podiatry, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand
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10
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Stewart S, Dalbeth N, Vandal AC, Rome K. Spatiotemporal gait parameters and plantar pressure distribution during barefoot walking in people with gout and asymptomatic hyperuricemia: comparison with healthy individuals with normal serum urate concentrations. J Foot Ankle Res 2016; 9:15. [PMID: 27134680 PMCID: PMC4851792 DOI: 10.1186/s13047-016-0147-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/26/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To identify spatiotemporal gait parameters and plantar pressure distribution during barefoot walking in people with gout and people with asymptomatic hyperuricemia by comparing them to healthy individuals with normal serum urate concentrations. METHODS Eighty-seven participants were included: 24 with gout, 29 with asymptomatic hyperuricemia and 34 age- and sex-matched normouricemic control participants. Spatiotemporal parameters of gait were assessed during level barefoot walking using a GAITRite® walkway. Peak plantar pressure and pressure time integrals were recorded using a TekScan MatScan®. Results were adjusted for age and body mass index. RESULTS Compared to normouricemic control participants, participants with gout demonstrated increased step time (P = 0.022) and stance time (P = 0.022), and reduced velocity (P = 0.050). Participants with gout also walked with decreased peak pressure at the heel (P = 0.012) and hallux (P = 0.036) and increased peak pressure (P < 0.001) and pressure time integrals (P = 0.005) at the midfoot. Compared to normouricemic control participants, participants with asymptomatic hyperuricemia demonstrated increased support base (P = 0.002), double support time (P < 0.001) and cadence (P = 0.028) and reduced swing time (P = 0.019) and single support time (P = 0.020) as well as increased pressure at the midfoot (P = 0.013), first metatarsal (P = 0.015) and second metatarsal (P = 0.007). CONCLUSION During barefoot walking, people with gout walk slower with plantar pressure patterns suggestive of apropulsive and antalgic gait strategies. Individuals with asymptomatic hyperuricemia also demonstrate altered barefoot gait patterns when compared to normouricemic control participants. Clinicians may consider dynamic gait outcomes when assessing and managing foot and lower limb related pain and disability in individuals with gout and asymptomatic hyperuricemia.
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Affiliation(s)
- Sarah Stewart
- />Department of Podiatry, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand
| | - Nicola Dalbeth
- />Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
- />Department of Rheumatology, Auckland District Health Board, P.O. Box 92189, Auckland, New Zealand
| | - Alain C. Vandal
- />Department of Biostatistics & Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand
- />Health Intelligence & Informatics, Ko Awatea, Counties Manukau Health, Private Bag 93311, Auckland, 1640 New Zealand
| | - Keith Rome
- />Department of Podiatry, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand
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11
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Stewart S, Morpeth T, Dalbeth N, Vandal AC, Carroll M, Davidtz L, Mawston G, Otter S, Rome K. Foot-related pain and disability and spatiotemporal parameters of gait during self-selected and fast walking speeds in people with gout: A two-arm cross sectional study. Gait Posture 2016; 44:18-22. [PMID: 27004627 DOI: 10.1016/j.gaitpost.2015.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/09/2015] [Accepted: 11/04/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To examine gait parameters in people with gout during different walking speeds while adjusting for body mass index (BMI) and foot-pain, and to determine the relationship between gait parameters and foot-pain and disability. METHOD Gait parameters were measured using the GAITRite™ walkway in 20 gout participants and 20 age- and sex-matched controls during self-selected and fast walking speeds. Foot-pain and disability was measured using the Manchester Foot Pain and Disability Index (MFPDI) which contains four domains relating to function, physical appearance, pain and work/leisure. RESULTS At the self-selected speed, gout participants demonstrated increased step time (p=0.017), and stance time (p=0.012), and reduced velocity (p=0.031) and cadence (p=0.013). At the fast speed, gout participants demonstrated increased step time (p=0.007), swing time (p=0.005) and stance time (p=0.019) and reduced velocity (p=0.036) and cadence (p=0.009). For participants with gout, step length was correlated with total MFPDI (r=-0.62, p=0.008), function (r=-0.65, p=0.005) and physical appearance (r=-0.50, p=0.041); stride length was correlated with total MFPDI (r=-0.62, p=0.008), function (r=-0.65, p=0.005) and physical appearance (r=-0.50, p=0.041); and velocity was correlated with total MFPDI (r=-0.60, p=0.011), function (r=-0.63, p=0.007) and work/leisure (r=-0.53, p=0.030). CONCLUSION Gait patterns exhibited by people with gout are different from controls during both self-selected and fast walking speeds, even after adjusting for BMI and foot-pain. Additionally, gait parameters were strongly correlated with patient-reported functional limitation, physical appearance and work/leisure difficulties, while pain did not significantly influence gait in people with gout.
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Affiliation(s)
- Sarah Stewart
- Department of Podiatry, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand Zealand.
| | - Trish Morpeth
- Department of Podiatry, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand Zealand
| | - Nicola Dalbeth
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand; Department of Rheumatology, Auckland District Health Board, P.O. Box 92189, Auckland, New Zealand
| | - Alain C Vandal
- Department of Biostatistics & Epidemiology, School of Public Health & Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand; Health Intelligence and Informatics, Ko Awatea, Counties Manukau Health, Private Bag 93311, Auckland, 1640, New Zealand
| | - Matthew Carroll
- Department of Podiatry, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand Zealand
| | - Lisa Davidtz
- Department of Podiatry, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand Zealand
| | - Grant Mawston
- Department of Physiotherapy, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
| | - Simon Otter
- Department of Podiatry, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand Zealand; School of Health Science, University of Brighton, 49 Darley Rd, Eastbourne, BN20 7UR, UK
| | - Keith Rome
- Department of Podiatry, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand Zealand
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