Treating Gout
It really is all about diet, but there is that scope of practice thing. Basically, it's about decreasing the purines in the diet - so they need to cut back on the wines and cheeses and deli meats like salami and whatnot. The pain comes from uric acid crystals that surround the joint and eventually attack and erode it if they don't make the dietary changes. They lack the enzyme to finish the breakdown of dietary purine. Gout medication is not a good idea, as one of the side effects IS gout - the very disease it's claiming to "treat"!
When tiptoeing around scope of practice, I mention that my professors discussed it today, and that they mentioned that the only real remedy is diet (which is indeed what they said), and tell them they can research it, that it's easily findable on Google. I basically hint at--or act as a messenger regarding--the main idea and then encourage them to do their own research.
In the meantime, it is not a good idea at all to work the area locally. Instead, you might work the thumb joints or thumb finger pads (ask the client for feedback as to which spots are tender to firm palpation as you pinch various ways around the thumb), which might have a palliative reflex effect on the gout-affected area.
Hope that helps!
Hugs,
~Jyoti