Today I want to actually emphasize on highly seen but moderately treated "Gouty Arthritis". Gout which is also known as "BIG TOE" in our laymen terms is actually the arthritis caused by increase in the uric acid levels. When this increase in the uric acid levels exceeds than the normal, it leads to the formation of small crystal which gets deposited on the 1st metatarsophalangeal joint. This might further lead to joint inflammation causing pain and limitations of the movements. I recently came across two cases of gouty arthritis. The first case was of a 43-year old man suffering from gout. The second case was of a 14 year old teenager. The symptoms of pain and inflammation were seen on bilateral lower extremities 1st metatarsophalangeal joints. The patient reports of difficulty in performing heel rise or standing on the toes. The patient also reported of pain on hyperextension of the 1st MTP Joint (metatarsophalangeal joint).

Physical Therapy: The most likely goal to be achieved over here is to cut the symptoms of pain and inflammation. To combat pain, physical therapists can use various modalities like muscle stimulation, hot packs and gentle mobilization for the joint range improvement. I recently tried the contrast bath method for the joint pain relief. I could clearly see that the patient showed 75% difference in his complain of pain. The pain reduction might be due to the vasodilation and constriction mechanism caused by the contrast bath method. The other technique that I found really attractive and worked to my surprise is "Stretching". I found that performing the stretching of peroneus longus proved quite effective for the patient. The patient reported decrease in the pain from 8/10 to 6/10 on the visual analogue scale. The deep tendon tissue massage also produced a positive response in the patient.

Well as we have normally seen gout in the middle age patients I recently came across an article that states that younger patient who are obese can also suffer from gout. The article is presented by Demarco et al (2011). This indeed opens up the options for evidence based research. The research evidence suggest that obesity is not only associated with gout, but young obese patients are also at high risk for the onset of gout.

So how does this imply in our physical therapy practice. If you get an obese young patient with the symptoms of pain and inflammation in the MTP joint, will you ever consider other consequences associated with the symptoms? PT's normally come across younger patients with the symptoms of pain and inflammation in the foot, ankle, knee etc. We rather likely take outdoor games as one of the reason for the symptoms. Whereas for now it is important for us to look back for the symptoms which can be the likelihood of other pathologies and not just outdoor games.. "Broad Mind and thinking out of the box is an important step in today's PT practice"

Thank You,
Sweta Christian, PT.
http://www.PractisingPT.com

Reference: Demarco, M. A, Maynard, J, Huizinga, M.A, Baer, A. N, Kottgen, A, Gelber, A. C & Coresh, J. (2011). Younger age at gout onset is related to obesity in a community-based report. Arthritis Care Res (Hoboken). 2011 August; 63(8): 1108€"1114