Gout Enthesitis Knee Ankle Heel

“Should I walk or engage in any exercise when I have gout?” Many people with gout ask themselves this question. And the answer is yes — except during a painful gout flare, according to Maura Daly Iversen, PT, MPH, DPT, SD, FAPTA, a physical therapist and behavioral scientist/clinical epidemiologist with a primary focus in rheumatology and Dean of the College of Health Professions at Sacred Heart University in Fairfield, Connecticut.

“When in a gout flare, even the pressure of a bed sheet can be extremely painful,” Dr. Iversen says. “Most patients feel better by elevating their feet and resting” — and that’s okay.

Safe Movement During a Gout Flare

Gout is caused by a build-up of high levels of uric acid in the body that forms microscopic crystals. (Uric acid is a normal metabolism waste product.) These uric acid crystals can settle in your joints, often in your big toe at the middle joint or where your toe connects to your foot. A build-up of uric acid crystals can also settle in your midfoot joint and your ankle, creating severe pain that is sharp, may be visibly swollen, and may even look red and feel warm to the touch.

“These lower extremity joints are weightbearing joints, so movement such as walking is difficult and very, very painful when someone is in a gout flare,” Dr. Iverson says.

A typical gout flare can last up to two weeks, though it can start to feel better quickly when treated with anti-inflammatory medication.

When you’re in the midst of a gout flare, Dr. Iversen recommends reducing weight on your feet and other weightbearing joints by using a walking aid, such as a cane, that you hold in the hand opposite your affected foot in order to unload the joint.

“Unloading the joint relieves the force put on your joint, which can reduce inflammation and allow you to move about for your daily activities,” she says. You can also use ice and cold to reduce inflammation and relieve pain, but this should be based on your personal tolerance as the joints can be very sensitive.

Anti-inflammatory drugs such as non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, and glucocorticoids may be prescribed by your primary care physician or rheumatologist to relieve pain during acute gout flares.

Different medications, such as allopurinol, are used to keep your uric acids level low and prevent future gout flares. Uric acid-lowering therapy, as this is known, is typically recommended for people who get two or more gout flares a year, have tophi (visible bumps of uric acid under the skin), or have joint damage from gout that is visible on X-rays, according to the most recent gout treatment guidelines from the American College of Rheumatology.

“One comment I have heard from patients taking uric acid-lowering medication is that as they take their medication, pain may increase. This can happen as the medication can start to break up the uric crystals, leading to discomfort. However, patients should not stop taking their medications without speaking with their rheumatologist,” Dr. Iversen explains. “Breaking up the crystals can help reduce joint damage. This pain will decrease as the crystals dissolve.”

Why Walking and Exercise Matter When You Have Gout

If left untreated, gout can erode and destroy your joints, according to the Mayo Clinic. That’s why it’s important to follow your medication treatment plan. Keeping your joints healthy when you have gout should also involve physical activity and exercise for two main reasons:

1. Maintaining a healthy weight prevents excessive weight-bearing force on your joints

Coincidentally, a healthy diet to control weight, such as the DASH diet designed to reduce high blood pressure, has been found to help people reduce their uric acid levels, according to this 2016 study. Be careful not to lose weight too quickly, as this sudden weight loss can raise uric acid.

2. Exercising helps control gout by lowering uric acid levels to prevent gout attacks

Researchers have found that fat in the body carries more uric acid than muscle. Thus, when you reduce body fat, you can reduce uric acid levels in your blood, Dr. Iversen notes. Building cardiovascular health through exercise is also very important for people with gout because they have a higher risk of developing high blood pressure, according to Harvard Health. Gout is also strongly associated with developing coronary artery disease.

Easing Back Into Walking and Exercise After a Gout Flare

After a gout flare subsides, Dr. Iversen suggests aquatic (water) exercises may be a good way to start re-engaging in exercise because “the buoyancy of the water will reduce the impact on the joints.”

Low-impact aerobic exercises can be helpful, too, such as on an elliptical machine. She says it’s important to keep your joints flexible by incorporating stretching and range-of-motion exercises once the gout flare subsides to promote good joint movement.

Be careful not to overdo it once you ease into post-flare exercise, she cautions. “Patients should not be experiencing pain when walking once the flare has subsided. If you do experience pain with walking after a flare, go back to using a walking support and reduce your planned exercise until the pain subsides.”

Expert Tips for Exercising When You Have Gout

Having gout doesn’t mean you can’t be active or even run on a regular basis, the key is to increase your workout intensity gradually, Dr. Iversen recommends, adding that you should consult your physician and physical therapist before starting any exercise routine.

She suggests these five gout-friendly workout tips to start and keep moving with gout:

1. Choose the right footwear

Because gout often affects the big toe, midfoot, and ankle, choosing good footwear is important. Dr. Iversen says a physical therapist can help evaluate the best footwear for a patient with gout based on evidence that shows specialized footwear provides benefits for patients by changing the alignment of the leg and foot, influencing the activity of the muscles of the foot, and your gait pattern (the way you walk). These modifications are designed to decrease the pressure (load) on your joints.

2. Follow a comfortable walking pace

Remember, your goal is to move without pain. Start slowly, using a walking pace that creates the least amount of stress and pressure, Dr. Iversen suggests. As you feel comfortable with your walking stride, test a gradually faster pace that increases your heart rate.

3. Include other low-impact aerobic exercises

Beyond walking, consider adding different heart-pumping activities into your regular aerobic exercise, such as swimming or riding a stationary bike. (Both of these are especially good options for gout patients because they don’t put as much pressure on the weightbearing joints of the feet, ankles, and knees.) An elliptical machine can be a smart choice to get your arms and legs moving without excessive joint force, she adds.

4. Stretch your affected joint

Once your gout flare subsides, you want to regain flexibility in the joint to ensure ease with movement. Dr. Iversen recommends simple stretching by slowly moving your joint forward, back and then around to a comfortable limit. Repeat five times and gradually increase repetitions.

5. Build muscle with strength exercises

Having strong muscles can protect your joint from wear and tear, especially for joints affected by gout. Beyond weight training, simple resistance exercises (that use your own body weight) can be effective to build muscle. For example, try an elastic resistance band by holding each end and putting your foot in the middle, then repeat your flexibility exercises while pushing against the force of the band.

The key with any exercise after a gout flare is to go slow and listen to your body, Dr. Iversen stresses.

Check Out The Gout Show

The Gout Show is a new podcast series for people living with gout and their loved ones, whether you’ve been managing gout for years or are newly diagnosed. Host Steve Clisby, who was recently diagnosed with gout, interviews fellow patients and gout experts to explore the basics of this often-misunderstood disease, debunk common myths, and share useful tips for taking control of your health. You’ll learn from gout patients and renowned doctors what living with gout is all about — and how to do it better. Check it out here.

Abbott RD, et al. Gout and coronary heart disease: the Framingham Study. The Journal of Clinical Epidemiology. January 1988. doi: https://doi.org/10.1016/0895-4356(88)90127-8.

All About Gout. Harvard Health Letter. July 2019. https://www.health.harvard.edu/newsletter_article/all-about-gout.

Allopurinol. American College of Rheumatology. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Treatments/Allopurinol-Zyloprim-Aloprim.

Gout. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897.

Interview with Maura Daly Iversen, PT, MPH, DPT, SD, FAPTA, a physical therapist and behavioral scientist/clinical epidemiologist with a primary focus in rheumatology and Dean of the College of Health Professions at Sacred Heart University in Fairfield, Connecticut

Juraschek SP, et al. Effects of the Dietary Approaches to Stop Hypertension (DASH) Diet and Sodium Intake on Serum Uric Acid. Arthitis and Rheumatology. December 2016. doi: https://doi.org/10.1002/art.39813.

Riskowski J, et al. Arthritis, Foot Pain & Shoe Wear: Current Musculoskeletal Research on Feet. Current Opinion in Rheumatology. March 2011. doi: https://doi.org/10.1097/BOR.0b013e3283422cf5.

Tsushima Y, et al. Uric acid secretion from adipose tissue and its increase in obesity. The Journal of Biological Chemistry. September 2013. doi: https://doi.org/10.1074/jbc.M113.485094.

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