Can You Have Gout in Your Heel?
Medically reviewed by Stella Bard, MD
Gout is a type of inflammatory arthritis caused by a buildup of uric acid within the body. In addition to affecting joint spaces, most commonly of the big toe, uric acid can also accumulate around tendons, bursae, and the kidneys.
A gout flare affecting the joint and tendons of the heel can lead to pain and swelling, often mistaken as plantar fasciitis.
This article will focus on symptoms, diagnosis, and treatment options of gout affecting this very sensitive area.
SDI Productions / Getty Images
Symptoms of Gout in the Heel
The symptoms of a gout attack or flare-up affecting the heel typically come on suddenly and intensely and can include:
Severe pain
Swelling and warmth
Redness
Difficulty walking or weight bearing
Decreased range of motion of the ankle
Often these symptoms can begin suddenly at night, leading to disrupted sleep. Chronic gout in the heel can also lead to limited range of motion and chronic pain.
What Causes Gout in the Heel?
Gout is an inflammatory form of arthritis caused by an accumulation of excess uric acid, also known as hyperuricemia. Hyperuricemia develops from either urate overproduction or urate underexcretion:
Overproduction of urate can occur for a number of reasons, including:
Genetics
Obesity
Increased cellular turnover (common in people with cancer, undergoing chemotherapy, or with other inflammatory diseases)
Diet that is high in shellfish, red meats, processed foods, and/or beer
Medications such as diuretics
Diagnosing Gout in the Heel
Since symptoms of gout can mimic other conditions such as plantar fasciitis, it is important to see a healthcare provider to receive an accurate and timely diagnosis. A rheumatologist specializes in inflammatory and joint diseases, such as arthritis and gout, and will be able to properly diagnose symptoms.
Gout can be definitively diagnosed during a flare-up, when a sample of fluid is removed from the swollen, affected joint and uric acid crystals are identified under microscopic evaluation. In addition to a thorough history and physical examination, blood testing and imaging studies can also aid in making the diagnosis of gout in the heel.
Blood Tests
A single blood test alone cannot diagnose gout, but it can be a helpful piece to the diagnostic puzzle. While some people with gout may have low to normal levels of uric acid, most will have a high level during a flare-up as defined as 6.8 milligrams per deciliter (mg/dL) or higher.
X-Ray
Uric acid crystals are not visible on X-ray imaging, however, joint damage caused by chronic inflammation and recurrent gout flare-ups can be. Joint space narrowing is a common finding.
Ultrasound
Ultrasounds can help detect fluid in and around joint spaces, as well as inflammation within surrounding tendons, particularly the Achilles tendon of the ankle.
An ultrasound can also be used to guide the needle during a joint aspiration when trying to obtain fluid from the affected joint. This ensures the needle is inserted into the correct space for fluid removal.
Dual-Energy CT Scan
If joint aspiration is unsuccessful or fails to demonstrate urate crystals, dual energy CT scans may be considered.
Dual-energy CT scans have been found to accurately identify monosodium urate crystals in people with suspected gout, however, they may not be as accurate in people who very recently started experiencing symptoms.
Treatment Options for Gout in the Heel
Medications and dietary and lifestyle modifications can help control inflammation and uric acid levels and prevent future flare ups from occurring. Chronic inflammatory conditions that are better controlled have a lower likelihood of causing complications.
Medications
Given the severity of symptoms during an acute gout flare-up, medications can help quickly reduce and manage pain and swelling. Medications commonly used during a gout flare include:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Corticosteroids
Colchicine
Once the flare-up has subsided and perhaps equally as important, is the need to prevent future flare ups from occurring. This can be done by using urate-lowering medications such as Allopurinol, Uloric, or Krystexxa to name a few. Of note, these medicines should not be taken during an acute flare as they may worsen the severity of symptoms.
Home Remedies and Lifestyle Changes
When it comes to managing chronic inflammatory types of arthritis, medication along with lifestyle changes provide the most long-term success in disease control. Some home remedies and lifestyle modifications that can help reduce disease activity include:
Avoiding shellfish, red meats, organ meats, and processed foods
Avoid alcohol (especially beer)
Cool compress to the heel and ankle
Cherries or Tart cherry juice
Can Gout in the Heel Cause Complications?
If left untreated, chronic gout can lead to numerous complications, including severe or permanent joint damage and destruction. If inflammation and an accumulation of uric acid are not treated, the joints can become damaged.
Another complication includes the visible accumulation of uric acid crystals in and around joints or under the skin, which is known as tophi. Tophi, especially in the hands and feet, can cause difficulty in day-to-day activities, such as walking or fine motor movements.
When to Contact a Healthcare Provider
Most gout flare ups will resolve within a few days to a few weeks. However when it comes to inflammatory forms of arthritis, treating flare-ups quickly can help reduce the risk of developing permanent, long-term complications.
If you are experiencing pain, swelling, difficulty walking, or decreased range of motion of the ankle and heel, seek the advice of a qualified healthcare professional.
Summary
Gout can lead to severe swelling and pain in the heel or ankle and can cause difficulty walking or putting weight on the affected foot. Gout is caused by an accumulation of uric acid and needs to be treated promptly to avoid complications such as joint destruction or tophi formation.
It is crucial to seek the advice of a healthcare professional to ensure proper diagnosis and treatment of gout of the heel. Through blood tests, imaging studies, and fluid analysis the correct diagnosis of gout can be made and there are numerous options for treatment of an acute flare as well as prevention of future flare-ups.
Read the original article on Verywell Health.
