Evaluation of foot and ankle characteristics in people with gout, chronic kidney disease and diabetes

The project aims to:

• identify the foot characteristics associated with chronic gout and compare these with foot characteristics seen in people with gout and diabetes and with diabetes alone
• determine the impact chronic gout has on pain, impairment and disability in these three groups
• ascertain relationships between foot outcomes and chronic kidney disease, adjusting for gout severity and characteristics.

Patients with a history of gout, chronic kidney disease and diabetes will be included into the study. We will measure demographic characteristics, foot and ankle characteristics that includes (i) measures of structure and function; ii) lifestyle and social factors; (iii) footwear suitability; (iv) tissue viability and skin and nail assessments; (v) baseline measures of foot impairment; (vi) the impact of any previous interventions, including surgery, footwear and foot orthoses.

New Zealand (NZ) has one of the highest prevalence rates of gout in the world with recent prevalence estimates of 2.34 per cent in Europeans, 6.06 per cent in Māori, and an even higher 7.63 per cent in Pacific Islanders. Furthermore, this prevalence is rising in NZ and is matched by a rising number of hospital admissions for gout. Although gout most commonly affects the first metatarsophalangeal joint (1MTP), minimal research has been undertaken surrounding the pathogenesis of 1MTP gout. The relationship between gout and diabetes is complex. Patients with gout have a high prevalence of type 2 diabetes, yet in contrast, the prevalence of gout in patients with type 1 diabetes was considerably lower. Gout may have implications for diabetes management: active arthritis restricts exercise, gout may provide additional complexity to dietary management, medications for acute gout may contribute to diabetes complications and severe gout may lead to more complex foot disease.