Case Study Analysis: 58-Year-Old Male with Right Foot Pain and Swelling

Introduction

This case study analyzes a 58-year-old obese white male presenting with acute right foot pain, swelling, fever, and chills. The analysis explores the potential neurological and musculoskeletal pathophysiological processes,

the influence of racial/ethnic variables, and their combined impact on the patient’s condition.

Neurological and Musculoskeletal Considerations:

• Gout: The most likely diagnosis is gout, an inflammatory arthritis caused by excess uric acid in the blood (hyperuricemia) leading to urate crystal deposition in joints, particularly the MTP joint of the big toe (Hallux) [(Zhang et al., 2020)]. This explains the sudden onset of severe pain, swelling, and inflammation in the right foot.
• Neurological involvement: Peripheral neuropathy is a common complication of diabetes, particularly in patients with poor glycemic control. This can lead to decreased sensation and impaired protective reflexes in the foot, increasing the risk of unnoticed injuries and potential infections [(American Diabetes Association, 2023)]. However, the patient’s normal sensation during the physical exam suggests neuropathy might not be a primary factor in this case.

Racial/Ethnic Considerations:

While gout affects all races and ethnicities, certain populations have a higher risk. Studies suggest a higher prevalence of gout among non-Hispanic white males compared to other racial/ethnic groups [(Zhao et al., 2020)]. This might be due to genetic predisposition, dietary factors, and socioeconomic disparities impacting healthcare access and management of co-morbidities like diabetes and obesity. However, these differences do not preclude gout from occurring in other populations.

Interaction of Processes and Patient Impact:

• Hyperuricemia and Inflammation: In gout, hyperuricemia leads to urate crystal formation within the joint space. These crystals trigger an inflammatory response, causing the classic symptoms of gout like sudden, severe pain, swelling, redness, and warmth in the affected joint [(Zhang et al., 2020)]. The patient’s elevated ESR and CRP support the presence of inflammation.
• Diabetes and Gout: Diabetes mellitus is a significant risk factor for gout. It can increase uric acid production and decrease its excretion, leading to hyperuricemia and gout attacks [(Yoo & Song, 2019)]. The patient’s uncontrolled diabetes likely contributed to his gout flare-up.
• Obesity and Musculoskeletal Stress: Obesity increases the stress on weight-bearing joints like the MTP joint. This chronic stress, combined with the inflammatory response in gout, can worsen the pain and limit mobility, as evidenced by the patient’s inability to bear weight on his foot.

Conclusion

The patient’s presentation is most consistent with acute gout. Hyperuricemia and urate crystal deposition in the right MTP joint likely triggered the inflammatory response, leading to pain, swelling, and fever. His uncontrolled diabetes and obesity further contributed to the severity of the gout attack. While racial/ethnic background plays a role in gout prevalence, it’s not a definitive factor in this case. Prompt diagnosis and management of gout are crucial to prevent future attacks and joint damage.

References

• American Diabetes Association. (2023, January 10). Diabetic neuropathy. American Diabetes Association. https://diabetes.org/about-diabetes/complications/neuropathy
• Zhang, Y., Doherty, M., Bardin, T., Nurminen, M., Khanna, D., Sokolove, J., … & Abhishek, A. (2020). Gout. Nature Reviews Disease Primers, 6(1), 1-22. https://www.ncbi.nlm.nih.gov/books/NBK546606/
• Zhao, H., Khanna, D., Nguyen, M., Bardin, T., Fitzgerald, J., Saag, K., … & Zhang, Y. (2020). Global estimates for the prevalence of gout and hyperuricemia in 2019: Results from the Global Burden of Disease Study 2019. Arthritis & Rheumatology, 72(4), 600-612. https://www.ncbi.nlm.nih.gov/books/NBK546606/
• Yoo, H. H., & Song, Y. W. (2019). Diabetes and gout: Two sides of the same coin?. Current Opinion in Rheumatology, 31(2), 142-148. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10739371/