Exploring Foot Pathology in Gout and its Impact on Wider Health-Related Quality of Life
Applications for this PhD project are now open. The deadline for applications is 6 April 2026.
Gout affects 1 in 40 people in the UK, with an increasing prevalence worldwide (Kuo et al 2015). Locally in Dorset, a 219% increase in gout incidence has been reported since 2019 (Patel 2024). Gout, together with associated cardio-metabolic comorbidities, is known to adversely affect overall quality of life (Watson 2023) and gout is associated with greater sickness absence (D’Angelo 2023). Gout has a predilection for the foot, the first metatarsophalangeal joint accounting for 73% of all gout flares (Stewart et al. 2016a).
Gout is also associated with altered gait patterns (Stewart 2016c ), loss of lower limb muscle strength (Stewart et al 2016b), poorer foot function (Petty et al 2019) and weakened tendon morphology (Stewart et al 2017, Otter et al. 2021). In contrast to other inflammatory arthropathies, (e.g. rheumatoid arthritis) where foot disease is known to have a negative effect on quality of life (Wickman et al, 2004, Otter et al. 2012, R-Cobo et al. 2020), the impact of the foot involvement seen in gout remains largely unknown.
Project Contact:
Dr Simon Otter
Email: simon.otter@hsu.ac.uk
Details
To explore the extent, impact and nature of foot-related pathology seen in gout on the wider determinants of well-being and health-related quality of life.
A mixed methods approach to the impact of foot pathology in gout on wider quality of life is proposed, as both the functional and experiential aspects of foot pathology are thought to be important.
The study will begin with a systematic review of the literature to synthesise existing literature focused on functional and experiential aspects of foot involvement in gout, seeking to identify gaps in knowledge, regarding its impact on health-related quality of life and well-being.
A quantitative survey will be developed, using validated instruments to delineate the nature, extent and impact of foot-related disease in gout together with measures of patient-reported outcomes and quality of life. This survey will be distributed in clinical settings and patient support networks via pre-existing links with GP surgeries and primary care. Statistical analysis will seek to determine associations between foot pathology and well-being indicators, such as mobility, employment, comorbidities and healthcare access.
An in-depth qualitative investigation, utilising semi-structured interviews, will explore the nature, extent and impact on quality of life of foot-related disease in gout. This section seeks to identify potential gaps in knowledge and gain a deeper insight into the lived experiences of individuals with gout.
This work seeks to Identify the impact of gout related foot pathology on wider health-related quality of life and determine opportunity for enhanced patient-centred interventions.
By examining pain, functional limitations, psychological well-being, and social participation, alongside factors like physical activity, employment, and healthcare access, this research will provide insights into the lived experience of gout in the foot. The findings will inform person-centred management strategies, contributing to a more holistic understanding of the impact of gout beyond pharmacological treatments.
Funding 
HSU is offering up to three fee waivers for UK home applicants starting in October 2026. All eligible UK home applicants will automatically be considered for fee waiver support, which is awarded competitively based on the excellence of the candidate.
International applicants are unfortunately not eligible for fee waivers.
All applicants are expected to have financial plans in place to cover their studies and should not rely on a fee waiver.
Self-funded students are also welcome to apply for this project. Self-funded students can be UK home students or international students.
Availability
Available to both UK and International students.
Potential Supervisors
References
Chapman LS, Backhouse M, Corp N, et al., British Society for Rheumatology Guideline Steering Group , The British Society for Rheumatology guideline for the management of foot health in inflammatory arthritis, Rheumatology, 2025, https://doi.org/10.1093/rheumatology/keaf071
D’Angelo S, Walker-Bone K, Goodson N, Gout and work participation in British adults: findings from the Health and Employment After Fifty study, Rheumatology, 62, Suppl 2, April 2023, P036, https://doi.org/10.1093/rheumatology/kead104.077
Kuo CF, Grainge MJ, Mallen C, Zhang W, Doherty M. Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Ann Rheum Dis. 2015;74:661–7. . doi: 10.1136/annrheumdis-2013-204463.
Otter S, Payne C, Jones AM, Webborn N, Watt P. Differences in Achilles tendon stiffness in people with gout: a pilot study. BMC Musculoskelet Disord. 2020 Oct 7;21(1):658. doi: 10.1186/s12891-020-03598-3.
Otter, S.J., Lucas, K., Springett, K., et al. , Identifying Patient-Reported Outcomes in Rheumatoid Arthritis: The Impact of Foot Symptoms on Self-Perceived Quality of Life. Musculoskeletal Care, 2012 10: 65-75. https://doi.org/10.1002/msc.1001
Patel R, 2024 The return of Victorian diseases. https://nowpatient.com/health-news/the-return-of-victorian-diseases.
Petty, H.R., Rathod-Mistry, T., Menz, H.B. et al. Foot structure, pain and functional ability in people with gout in primary care: cross-sectional findings from the Clinical Assessment Study of the Foot. J Foot Ankle Res 12, 8 (2019). https://doi.org/10.1186/s13047-019-0317-2
Reinoso-Cobo A, Gijon-Nogueron G, Caliz-Caliz R, et al Foot health and quality of life in patients with rheumatoid arthritis: a cross-sectional study BMJ Open 2020;10:
https://doi.org/10.1136/bmjopen-2020-036903
Stewart S, Dalbeth N, Vandal AC, Rome K. The first metatarsophalangeal joint in gout: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2016;17:69.
Stewart S, Mawston G, Davidtz L, et al. Foot and ankle muscle strength in people with gout: a two-arm cross-sectional study. Clin Biomech 2016;32:207–11
Stewart S, Dalbeth N, Vandal AC, Rome K. Spatiotemporal gait parameters and plantar pressure distribution during barefoot walking in people with gout and asymptomatic hyperuricemia: comparison with healthy individuals with normal serum urate concentrations. J Foot Ankle Res. 2016;9:15.
Stewart, S., Dalbeth, N., Otter, S. et al. Clinically-evident tophi are associated with reduced muscle force in the foot and ankle in people with gout: a cross-sectional study. J Foot Ankle Res 10, 25 (2017). https://doi.org/10.1186/s13047-017-0207-4
Watson L, Belcher J, Nicholls E, et al. Factors associated with change in health-related quality of life in people with gout: a 3-year prospective cohort study in primary care. Rheumatology (Oxford). 2023 Aug 1;62(8): 2748-2756. doi: 10.1093/rheumatology/keac706.
Wickman AM, Pinzur MS, Kadanoff R, Juknelis D. Health-Related Quality of Life for Patients with Rheumatoid Arthritis Foot Involvement. Foot & Ankle International. 2004;25(1):19-26. doi:10.1177/107110070402500105
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