Background Chronic foot- and lower limb-related impairment are frequently reported by people with gout who also demonstrate altered gait and plantar pressure patterns when assessed during shod walking . The impact of gout on plantar pressure distribution without the confounding effect of footwear is unknown. People with asymptomatic hyperuricaemia, who lack any symptoms or clinical features of gouty arthritis also report disabling foot pain and lower limb disability compared to normouricaemic controls . However, it unclear whether their gait and plantar pressure patterns also differ from healthy individuals.
Objectives To identify spatiotemporal gait parameters and plantar pressure distribution during barefoot walking in people with gout and people with asymptomatic hyperuricaemia by comparing them to normouricaemic controls.
Methods A total of 87 participants were included: 24 with gout, 29 with asymptomatic hyperuricaemia and 34 age- and sex-matched controls. 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 controls, participants with gout demonstrated increased step time (0.60 vs. 0.64 s, P=0.022) and stance time (0.74 vs. 0.80 s, P=0.022), and reduced velocity (1.03 vs. 0.91 m/s, P=0.050). Participants with gout also walked with decreased peak pressure at the heel (294.3 vs. 268.2 kPa, P=0.012) and hallux (233.3 vs. 208.4 kPa, P=0.036) and increased peak pressure (95.4 vs. 130.8 kPa, P<0.001) and pressure time integrals (23.5 vs. 32.7 kPa*s, P=0.005) at the midfoot (Figure 1). Compared to controls, participants with asymptomatic hyperuricaemia demonstrated increased support base (0.08 vs. 0.11 cm, P=0.002), double support time (0.16 vs. 0.26 s, P<0.001) and cadence (101 vs. 107 steps/min, P=0.028) and reduced swing time (0.46 vs. 0.43 s, P=0.019) and single support time (0.46 vs. 0.43 s, P=0.020) as well as increased pressure at the midfoot (95.4 v 120.1 kPa, P=0.013), first metatarsal (211.5 vs. 239.7 kPa, P=0.015) and second metatarsal (292.6 vs. 321.3 kPa, P=0.007) (Figure 1).
Conclusions During barefoot walking, people with gout walk slower with plantar pressure patterns suggestive of apropulsive and antalgic gait strategies. Individuals with asymptomatic hyperuricaemia also demonstrate altered barefoot gait patterns when compared to normouricaemic controls. Clinicians may consider dynamic gait outcomes when assessing and managing foot and lower limb related pain and disability in individuals with gout and asymptomatic hyperuricaemia.
Rome, K. et al. Clin Biomech. 2011;26: 90–94
Stewart, S. et al. J Foot Ankle Res. 2015;8:41–49.
Disclosure of Interest None declared