Can You Walk With Gout? My Tips as a Physical Therapist

What happens to our bodies during a gout attack?

Gout is the most common inflammatory joint disease (arthritis). And we know all about it, since it was already described by Hippocrates in ancient Greece (Fenando 2022)!

Here’s what happens in the body during a gout attack:

1. Formation of urate crystals: our blood contains uric acid all the time. When we have too much, it can crystallize and form urate crystals: this is the gout attack.
2. Joint deposition: these urate crystals tend to be deposited in the joints, generally in the big toe (the joint between the phalanx and the metacarpus). But also in other joints: knees, ankles, wrists, feet, elbows, sacroiliac joints (hip, pelvis, back) and in tendons and bursae.
3. Inflammatory reaction: when urate crystals irritate the tissues around the joints, this triggers an inflammatory reaction. It is this inflammation that causes the pain, swelling and redness characteristic of a gout attack.

The difficulty and pain of walking during a gout attack is due to theinflammation it causes.

How long does the pain of a gout attack last?

The inflammation of a gout attack is greatest within 12 to 24 hours of onset (Fernando 2022): this means that whatever you do, the worst time is at the beginning.

Naturally, you’ll be less and less inclined to walk as the days go by.

In general, a first attack of gout lasts 3 days to 2 weeks (Fernando 2022) even without any treatment. If there are further attacks later, they usually last longer.

60% of people who have a first episode of gout have a new one within a year, and 80% within 3 years (Fernando 2022).

Does walking cause gout flare ups? (+ Causes)

Excessive activity (such as walking or standing a lot, or playing sports that strain the joints) is not a known trigger for gout attacks.

There are mainly genetic reasons why some people have gout attacks and others do not. Up to 1 in 2 people with gout have relatives who have had it, and research teams have identified the genes involved.

Certain diseases or conditions also put us at greater risk of gout attacks: vitamin B12 deficiency, trisomy 21, obesity, pre-eclampsia, etc.

And here are the factors that are assumed to trigger crises:

• Stress: illness (especially cardiovascular disease), surgery, recent trauma, dehydration or fasting;
• Food and alcohol: purine-rich foods such as offal and seafood, beer, wine and spirits;
• medications: aspirin, diuretics, allopurinol.

You’ll note that walking, sport and physical activity are not among the triggers.

Source : Fenando 2022

On the contrary, an active lifestyle is a protective factor against inflammatory manifestations such as gout attacks. In any case, this is what has been observed in laboratory studies, particularly in animals: the anti-inflammatory effect of physical exercise (Jablonski 2020).

Can walking prolong a gout attack?

Treating a gout attack means trying to limit inflammation, from the very first 24 hours it occurs. Management is based on these 3 pillars:

• apply ice to the painful, inflamed area;
• taking anti-inflammatory drugs (NSAIDs), colchicine or systemic glucocorticoids ;
• rest the inflamed joint.

When a joint is inflamed, if it is put under too much strain, the inflammation can actually be greater. We need to find the right balance, because immobility is not a good thing either.

The difficulty in a gout attack is to find the right balance between overdoing it and underdoing it.

• Professionals preferring a precautionary approach: some doctors or physiotherapists will recommend that you keep your foot off the ground for a few days, until the inflammation subsides (if you have inflammation of the foot or lower limb).
• Professionals proposing a more active approach: a more liberal attitude (I’m in this camp!): others will tell you to simply take crutches if necessary to put a little less weight and strain on the leg, but to keep walking and moving, to benefit from the beneficial effects of physical activity.

There are no studies comparing the evolution of people who walk VS who have no support in the days following a gout attack, to see who fares better.

In these situations of uncertainty, I think you have to decide which is more to your liking: a precautionary attitude or a more dynamic one. There’s no right answer to this question, which is more a matter of personal choice.

Should I walk less than usual because of a gout attack?

It’s all a matter of personal preference!

🟢 If you feel that walking does not aggravate gout-related pain.

Walk as you please, and reduce the amount or intensity of your walking sessions if you really feel more pain in the night after a big walking session.

🟠 If you feel that walking aggravates gout-related pain, during or after.

Reduce the intensity or duration of your walking sessions. Consider taking walking sticks, crutches or a walker to put less weight on the foot on the side of the gout attack.

If footwear is a problem, wear open shoes, or shoes several sizes larger. There are also walking shoes or boots designed for people with big toe surgery, which may be appropriate to wear during a gout attack.

You can find these shoes in pharmacies and drugstores, at medical equipment retailers or on the Internet. We call them discharge shoes.

How can you walk with a gout attack if the pain is unbearable?

Here’s a quick rundown of things you can do if you still want to walk despite your gout attack (or if you simply have no choice!).

• Use crutches, walking sticks or a cane to put less weight on the joint where the gout attack is taking place.
• Walk without putting your foot down for a while, supported by your crutches. Here I explain how to walk on crutches without putting your foot down.
• Choose the most comfortable shoes possible: open-toe, one size larger, toe relief shoe.
• Apply cold to the gouty area before and after a walking session. (If you find it relieves the pain at least a little at the time).
• After walking, place your foot higher than your heart, in a sloping position, at the ease of leg rests or cushions. Fluids will probably stagnate lower down, reducing pressure and pain in the joint.

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I hope I’ve answered your main questions on the subject! If you have any comments, feedback or questions, please feel free to comment!

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📚 SOURCES

Fenando A, Rednam M, Gujarathi R, et al. Gout. [Updated 2022 Dec 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546606/

Jablonski K, Young NA, Henry C, Caution K, Kalyanasundaram A, Okafor I, Harb P, Schwarz E, Consiglio P, Cirimotich CM, Bratasz A, Sarkar A, Amer AO, Jarjour WN, Schlesinger N. Physical activity prevents acute inflammation in a gout model by downregulation of TLR2 on circulating neutrophils as well as inhibition of serum CXCL1 and is associated with decreased pain and inflammation in gout patients. PLoS One. 2020 Oct 1;15(10):e0237520. doi: 10.1371/journal.pone.0237520. PMID: 33002030; PMCID: PMC7529261.