Your client also has a history of gout.  Gout can affect one joint or can be polyarticular in nature.  The most common joints affected being the large toe followed by the tarsal joints, ankles and knees.   Episodes usually occur at night. These episodes are usually associated with traumatic  joint pain and swelling.  Joints become warm, red and tender.  This condition can adversely impact on one’s ability to stand, walk or perform psychophysical testing involving the use of the lower extremities.