Definition

Gout (uricopathy) is a purine metabolic disorder that proceeds in episodes and (with inadequate treatment) leads to bone resorption and cartilage changes in the area of the joints due to uric acid crystal deposits (urate) in various peripheral joints and tissues, and ultimately to renal failure caused by long-term damage to the kidneys as excretory organs. While kidney damage occurs without pain, it is a bigger problem than the painful gout attacks in the joints.

Acute symptoms include sudden, pronounced pain in a joint and severe pain in response to touch. The joint is reddened, extremely painful, severely swollen and hot. There are also general signs of inflammation such as fever, an increase in the number of white blood cells and elevated uric acid values prior to the attack (uric acid values are often normal during the acute gout attack). Headaches also occur in rare cases.
The joint becomes very painful, swollen and hot without any injury or other apparent cause. The basal joint of the big toe is frequently affected. But in theory, an acute case of gout – even the first time – can affect any joint.

Causes

A distinction is made between two causes of hyperuricemia, i. e. elevated levels of uric acid in the blood: the primary and the secondary form.

• The primary form is a purine metabolism disturbance. It is caused by an excretory disorder in the kidneys. The over-production of uric acid may also be the cause in very rare cases. The primary form is more common than the secondary.
• In the secondary form, various accompanying diseases cause the elevated uric acid levels.

In far more than 99 % of all cases (not involving external influences), hyperuricemia is caused by a kidney function disturbance. This can be hereditary and is autosomal dominant in this case. These patients suffer from a congenital excretion disturbance of the kidneys, with otherwise normal kidney function.
Hyperuricemia can also be a consequence of kidney function disturbances due to other causes, such as diabetes mellitus, since elevated blood sugar levels over extended periods of time damage the blood vessels, which in turn impairs kidney function.
The excessive consumption of alcohol is also harmful since carboxylic acid competes with uric acid in the excretion mechanism of the kidneys.
In addition, beer contains yeast residue which delivers additional purines that form uric acid.
The purine metabolism may be disturbed as well. Foods that form uric acid (examples):

• High uric acid concentration (more than 200 mg/100 g): Trout, herring, sprats, grilled chicken, liver, kidney, sweetbread, meat consommé and stock, instant soup cubes and baker’s yeast.
• Moderate uric acid concentration (80–150 mg/100 g): Plaice filet, ham sausage, muscle meat (beef, pork, chicken, game), legumes and peanuts.
• No/low uric acid (0–50 mg/100 g): Milk, yogurt, egg, pumpkin, peppers, potato, apple, whole grain bread, white bread and cheese. However, milk products are often enriched with fructose. When broken down after consumption, they produce IMP, which causes the concentration of uric acid in the body to rise through purine decomposition.
• The main purine sources among beverages are beer (10–23 mg/100 g) and cola (10 mg/100 g).

The purines contained in coffee, black tea and cocoa are not broken down into uric acid, so their continued consumption does not pose a problem.

Long-term consequences

Without treatment, gout attacks usually last two to three weeks. The duration of the attacks can increase as the disease progresses. The attacks can also overlap in the chronic phase, so that there are no pain-free intervals.
Chronic gout develops after several attacks have passed. The joints are destroyed. Characteristic defects appear on X-rays in the spongy bones close to the joints and there are significant defects on the head of the joint. Consequences include restricted performance, uric acid crystal deposits in the joints, joint deformities, kidney stones and kidney failure. When gout transitions into the chronic phase, the acute attacks often become less pronounced and less painful.

Conventional therapy

The medications below are prescribed for acute gout attacks. These medications only treat the symptoms:

• NSAR
  Impedes prostaglandin synthesis by reducing an inflammatory metabolism enzyme, thereby reducing pain and alleviating inflammation.
• Colchicine
  This medication is used increasingly less due to side effects. Prevents leukocytes (especially macrophages) from absorbing uric acid crystals (urate), thereby reducing the inflammatory reaction maintained by these cells and the cytokines they release. Use of the poisonous meadow saffron/autumn crocus goes back to the beginnings of medicine.
• Cortisol
  A hormone produced by the body that has a pronounced anti-inflammatory effect. The intra-articular and/or systemic administration of corticosteroids has gained greater importance in gout therapy in recent years, even though their effect has not been investigated in any meaningful studies.

Chronic gout:

• Dietary changes
  A diet low in purine is recommended, but this only results in a moderate reduction of uric acid levels. More pronounced effects on the level of uric acid in the blood were achieved with a moderate low-calorie and low-carbohydrate diet, with a higher proportion of protein and unsaturated fatty acids. Milk products are more suitable as high-protein foods here than meat or fish.
• Uricosuric agents
  They promote the excretion of uric acid by inhibiting its re-absorption by the kidneys.
• Uricostatic agents
  Xanthine oxidase inhibitors lead to reduced uric acid formation through the competitive inhibition of xanthine oxidase, which oxidises hypoxanthine to form xanthine and then uric acid. The resulting elevated hypoxanthine concentration also inhibits purine synthesis.

The kybun principle of operation – being proactive

Numerous causes of the disease can only be treated with lifestyle changes (nutrition, exercise) and medications. kybun can have a positive effect in case of gout and helps you change your lifestyle by making regular everyday exercise child’s play:

• The soft, elastic material of the springy mat or the kybun shoe sole is very comfortable and motivates you to move more often for longer. You regain the joy of movement and lose excess body weight at the same time.
• In addition to normalising blood sugar levels, increased physical activity also lowers high blood pressure and reduces the risk of nerve and blood vessel diseases.
• Your feet are gently cradled by the soft, elastic kybun material, protecting them against injury. The impact from hard surfaces is cushioned. This provides very welcome relief in case of joint pain. At the same time, you can gently feel the ground (stones, cobbles, natural soil) through the material, which improves foot sensitivity.
• The soft, elastic material allows your foot full freedom of movement. As a result you do not limp as much on the kybun mat/in the kybun shoe, which protects the joints throughout your body against excessive strain and wear.
• The natural rollover improves the health of the foot: Mobility, coordination and strength are increased and, thanks to improved functioning, the foot is better able to absorb the forces from the environment that act on the body while walking. This protects the higher joints against improper and excessive strain.

Application tips

• Since gout pain is relapsing-remitting, kybun shoe training should always be adapted to the user’s condition each day. It is important that the affected individual finds out over time how much kybun training is helpful and when it is time for a break in order to avoid increased pain afterwards. On some days, it may well be that only short and gentle kybun shoe training is required (or even skipping a day), while walking longer distances in the kybun shoe may be possible on other days.
  

  There should never be increased pain after kybun shoe training/walking (dosage) in order to effectively alleviate gout!
  This is of particular importance with all inflammatory diseases! With regular walking in the kybun shoe, the body will adjust over time (stronger muscular and connective tissue, more stable joints). Complaints/initial reactions will occur less quickly and frequently.

  More helpful tips:

• If the rollover on the big toe is very painful, you can reduce the pressure on the big toe as follows:
  1) Take shorter steps
  2) Put a stiffer, thin insole into the kybun shoe. This reduces the softness of the kybun shoe sole, resulting in less mobilisation of the big toe.
• If you feel ‘new’ pain in the kybun shoe or on the kybun mat, or if your existing pain gets worse, this may be due to various reasons (e.g. unfamiliar, more upright posture, tense muscles, movements that are unfamiliar for the body).
• We advise you to perform the kybun exercises regularly every now and again. They loosen the muscles and straighten the body. This relieves strain on the joints.
  Choose the kybun exercises that are good for you! Some customers prefer easier movements while others find the more intensive exercises helpful; this is highly individual.
• Choose a kybun shoe with a lower rebound effect. It provides you with greater midfoot stability. Ask your kybun dealer to show you the various models.
• If you feel unstable wearing the kybun shoe or are looking for an additional training device to use at home, the kybun mat is the ideal alternative. You can strengthen the foot, leg and back musculature at home on the soft, elastic springy mat. You can hold on to a fixed object if you feel unstable. The kybun mat is also available in a choice of different thicknesses (the thicker, the more intensive the training). Ask your local kybun dealer for advice.
• If you get very fatigued in spite of the kybun exercises, or if you feel pain or in case of lateral/medial rolling of the ankle joint on the kybun sole, we advise you to take a short kybun shoe/kybun mat break until the symptoms go away.
• Be sure to maintain an upright postureandkeep your gaze forward (do not look at the floor). You should walk straight on the kybun shoe sole and correct any lateral/medial rolling of the ankle joint!
• If you have further questions or concerns, please contact us or a kybun dealer near you.