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 joint disease caused by increase in the uric acid levels. When this increase in the particular 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 combined inflammation causing pain and limitations of the movements.
- Recently i 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 had been seen on bilateral lower extremities 1st metatarsophalangeal joints.
- The individual 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 be able to combat pain, actual therapists are able to use numerous modalities like muscle stimulation, hot packs and gentle mobilization for the joint range improvement. I recently tried the contrast bath way of the joint pain relief. I could clearly see that the patient confirmed 75% difference in his complain of pain. The pain lowering might be due to the vasodilation and constraint mechanism due to the contrast bath method. The other technique which I found really attractive as well as 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 heavy muscle tissue massage also created 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 a good obese young patient with the symptoms of pain and inflammation in the MTP joint, are you going to ever consider other consequences associated with the symptoms? PT's normally come across younger patients with the signs of pain and inflammation in the foot, ankle, knee and so on. 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 to the symptoms which can be the likelihood of other pathologies and not just outdoor games.. "Broad Mind and also considering out of the box will be an important step in today's PT practice"
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
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