PT on the Net Research

Gout in Ankle


Question:

I have a client who suffers from gout in the ankle. He wants to get fit, so what would you suggest? He is also hypertensive, NIDDM and overweight.

Answer:

With this many risk factors, you may want to get a full medical clearance from a qualified medical professional before you do much of anything.

Gout is ultimately caused by an increased level of uric acid within the body. Rather than being removed by the kidneys and flushed through the urine, it forms needle-like crystals that get deposited either in the connective tissue, the joint space between bones or both. This leads to very painful inflammatory arthritis, which presents as swelling, redness and heat and pain and stiffness in the affected joint.

If the gout is actively causing inflammation in the joint, it may not be advisable to exercise that joint. Exercise may actually prolong the inflammation and perpetuate the client’s pain. Typically in this state, efforts should be geared toward resting the joint and reducing the painful inflammation with ice and NSAIDs.

You may be able to implement some pool work if a pool is available. Just remember to minimize lower body activity in the water. You can also do some upper body cardio such as an arm ergometer.

After the inflammation of the joint has dissipated, you may be able to slowly implement some closed chain exercises to build strength and stability in the joint. Eventually, you may be able to get more aggressive with different types of cardiovascular exercise, but you should not rush the process.

Considering the gout and his other risk factors, your focus should probably be on weight reduction. However, you should monitor his weight loss and make sure he is not losing weight too quickly. Rapid weight loss may actually raise the uric acid levels in the blood, which would obviously be counterproductive.

Nutritional Considerations

You might find that weight reduction through moderately limiting calories may be his most efficient plan of attack. With this individual’s particular list of risk factors, you may want to suggest he work with a registered dietitian. With the addition of the hypertensive and diabetic issues, he should really be monitoring his diet, and this may be somewhat tricky.

The use of alcohol and certain foods that are high in purines such as seafood, kidney/liver/heart/gizzard meats, cocoa, peas, spinach, lentils and beverages such as tea and coffee can cause an incidence of gout. You may want to ensure he is staying properly hydrated. Water can help the removal of uric acid and decrease the potential of another flair up.