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Has anyone had experience with hypersensitive gout cases? Is it possible to cause a flare up in both ankles after a regular biomechanical assessment ie joint ROM muscle testing, gait analysis etc? To flare up enough that hospitiliasation is required and time off work?

MAy seem a strange question but is a real case. Can such minimal trauma cause such an aggressive response?

Interested on other peoples experience with this prob.

Cheers

Mark

Are you sure it was gout?

Gout is due to: underexcretion of urate (more common) and/or overproduction of urate (less common). It requires the deposition of monosodium urate crystals in joint and a local inflammatory response to the crystals. I fail to see how any sort trauma can cause gout??? Gout does tend to occur more often in joints with longer term trauma (eg 1st MPJ).

But I have my doubts:
* Gout is less common in the ankle joint (your's is in the ankle)
* Gout is more likely unilateral than bilateral (your's is bilateral)
* Gout is incredibly unlikely to be severe enogh to need a hospitalisation (unless that have that “Diuretic” gout and renal impairment)

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Mark,
The bursa surrounding soft tissues are regularly missed as gout based path. So i am not sure if this is possible in the case you are mentioning.
The joint itself is highly reactive when involved and most definitely can occur in the ankle and is probably under reported as a potential cause of acute pain. But as Craig mentioned it is more likely to present unilaterally.
This does not mean bilateral is impossible just not as common as other presentations. But to your question of routine exam? yes most definitely this could create reactive changes in the joint to the point of excrutiating pain and is highly likely to contribute to hospitalisation and time off work.
I have seen 2 cases this last week of gouty presentations which were a little unusual.
1. anterior ankle pain with gross swelling and inability to walk(time off work) x-ray NAD. prior history of patella bursitis, blood work up for dx as gout-meds alleviated.
2.anterior knee pain non-specific cause, dx as prepatella bursitis previously but on aspiration gouty bursitis - meds alleviated.
I am not sure why the patella bursa was involved in both cases? If anyone has any suggestions then shoot!
Poddy (formerly known as and maybe known in the future as DaFlip)

having kidney disease i am prone to gout, two episodes of which occurred after prolonged static weightbearing (2-3 hrs) on concrete.......is that minimal trauma enough????

Thanks for the replies, You have echoed my concerns and as you say this bilateral pressentation is definately one out of the box. The hospital staff did not diagnose this as a gouty attack as uric acid levels only a little above normal. There is also no signs of renal impairment. His originall complaint was unilateral posterior calc pain - unable to fully diagnose as he is not returning as he feels my exaMINATION set off this sequence of events.

Also if joint ROM testing can cause this amount of swelling etc, surely spending a day on your feet simply walking will cause more joint trauma/increased forces etc than a biomech exam. This guy should probably be in agony all day everyday, if this is the case.

Thoughts???

Cheers
Mark

This could be a very odd case of gout.However,the odds do not favor that.You can start to think of causalgia/RSD here as well.

Hi
My partner gets gout in his right first MPJ the first day of our last three holidays.It does not matter if the flight is 1 or 4 hours and there was no partying before hand or trauma yvonnespod

To yvonnes pod:If your partner is on a flight,maybe the fact that he(or she)is sitting in a recumbent position.I still see this more around the holidays due to alcohol intake and increased consumption of rich foods .This is due to the fact that the rich foods are purine rich.The alcohol,in addition to being rich,is also a diuretic.Any diuretic can cause gout.Is your partner on water pills?

Yes John
I agree but this is immediately before the rich/change of food or copious amounts of alcohol maybe its the stress of family togetherness!! Emotional trauma

Gout,
I also have had high uric acid levels (.66)
1st Attack right knee
2nd " right forefoot
3rd " left ankle
4th " riight lateral side of foot

I do not drink alcohol but I love my chocolate.
the first attack 2001, The last attack February was associated with meat, bacon and onion.

Don

Gout can occur after trauma. after the initial episode (flare) a relapse followws even without any intervention. presence of monoswodium urate crystals in the joints during the assymptonmatic relapse phases suggest an equilibrium between the MSU crystals and the proinflammatory materials. a traumatic event (physcial and emotional stress, anxiety, high purine intake and alcohol consumption) can disturb this equilibrium triggering the flare.

gout occurt predominently on one side (assymertric) however, there are case studies inthe literature with bilateral involvement.

5 case studies (out of 15 reported inthe medical literature) reorted gout flares inthe ankle region (distal tibiofibular joint, calcaneus, talus, distal tib-fib ligaemtn and A tendon). however the midfoot takes the second place with the first MTPJ taking the first place in prevalence.

Hope this helps

David

Definitely, interestingly, i have had 3-4 day bushwalking sojourns and have had no resultant gouty episode yet I have twice ridden to work (10 minute easy) and have had attacks within 1/7. Methinks the emotional stress angle, riding to work, has merit.
Yep, all my early episodes were either the 1st mpj right/f or nav-cun. region left/f.
However the last episode, which lasted ~ 5/52 involved firstly my left midfoot, then my left knee, then my right knee (as I had heavily relied on it when my left knee was affected) and finally ended in my right/f. For 2/52 it was in both knees which proved a wee problem!
mark

i have had 3-4 day bushwalking sojourns and have had no resultant gouty episode yet I have twice ridden to work (10 minute easy) and have had attacks within 1/7.

Hello sir,
INtrestng, has the cycling happened after the bush walk? if thats so, do u think excessive strain could trigger the flare?

the definition of traume used in the literature is 'imjury' or a bump . repetiitve stress as in ur case is not mentioned to my knowledge.

david

David It's Mark
Nope, but pushing down on pedals is "unnatural".
Opportunity for your next paper!
All the best, mark

Hi Mark,

as u mentioned pushing down on pedals is an unnatural movment, would u reckon an abnormal movement can trigger a flare? a study by Gentle (2005) reported excessive pain with abnormal joint movement during gout flare in chicken ankle joints. what do u think? could abnormal movement trigger a flare?

David

Goodaye David, yes, though i realise 'correlation doesn't prove causation", mark

Hi Mark,

excuse my insignificance, i was wondering, if cycling is an abnormal motion then why is it used as an rehab modality for knee injuries and post surgery rehab?

david

David, bad opening. Is cycling used in post surgical rehab. for feet? Maybe it's the unusual forces applied to the bones plantarly that's abnormal? all the best and a merry christmas, mark