This page heel gout page 1 was last reviewed, or updated, on 16 November 2015
There is a link to heel gout page 2 at the bottom of this article
Remember that gout is not just a disease of the joints – its crystals can be deposited in many body areas. In the heels there are four places where gout can flare up and three are not joints.
Where gout attacks the heel There is an attackable joint – the subtalar joint between the heel's calcaneus and talus bones. But also gout can, and as usual, inflame the bursa(e), the cushioning sac(s) beside the Achilles tendon. Deposits of its crystals elsewhere in the heel's tissues can set off an attack too, and eventually grow into a tophus (if one) or tophi (if more than one), if treatment is not successful. Fourthly tophi can deposit on the Achilles tendon, and in rare cases break it.
Diagnosing heel gout can take time The problem with gout of the heel is that other troubles in the same areas can make diagnosing gout correctly and quickly, difficult – a similar problem to diagnosing wrist gout. Many folk have gone through more than one diagnosis, including diagnosis by elimination of other problems, before gout has been finally identified. So you may find yourself dealing with something else before you find out you have gout. Heel gout could flare in either heel, even in both simultaneously. It has no favourite (favorite) heel – left or right makes no difference.
PAIN, IS IT HEEL GOUT? “
The best test for a correct diagnosis of gout is whether the needle-shaped MSU gout crystals can be seen under the lens of a polarising (polarizing) microscope. The test requires removing synovial fluid out of a joint. It's called joint aspiration or arthrocentesis.
However, in some joints it's difficult for the doctor to get enough synovial fluid out, to examine for the presence of gout crystals. Unfortunately, the subtalar (aka the talocalcanean joint) heel joint is one such joint, although there is fluid there.
The heel's calcaneus bone
If you have heel pain, but none of the hallmarks of gout as listed on the second wrist gout page, plantar fasciitis is much more likely than heel gout. PF is the most common foot pain.
But for this to happen you would have already had a gout attack in
your ankle and you would know this.
Rectifying shoe insoles (orthotics) can help with plantar fasciitis; so too can well fitting shoes, losing weight, exercises, icing the area, and resting the foot. If you can bear to wear shoe insoles it's not likely to be gout, because during most of a gout pain episode you can't bear to be touched by anything.
Here's another way of telling whether it's plantar fasciitis or gout. Ask yourself what is the pain like ? Plantar fasciitis (PF) pain often fluctuates during the day; gout's pain is more likely to be worse at night than during the day when the attack is at its height. When gout pain goes, (3-10) days, it's usually gone till the next attack in gout sufferers who are not at the chronic stage. (After about 5 years of gout). At the chronic stage of gout, the pain may trip around the joints or be a dull ache. (See below). Plantar fasciitis (PF) pain doesn't take a trip around the joints, but it can be a dull ache. Moreover, the swelling of gout will probably be greater than the swelling of PF.
gout pain, which can come on suddenly and intensely, often at night, and reach
a continuous peak in 12-24 hours, plantar fasciitis pain develops gradually. It
affects one foot but gout can hit both simultaneously. And usually, very unlike
gout pain, it's at its worse for a short while after a rest or during the first
steps in the morning when it can be sharp and stabbing. Then it goes away or
becomes a dull ache, and maybe returns later. Gout pain doesn't behave like
this after a rest, or during the morning’s first steps.
Gout pain is hot or warm, throbbing and sore if you touch it. But sense this; don't touch it unless you want a stabbing pain. When gout pain goes, the affected area can be itchy.
pain is a sign of gout
There is another kind of gout pain in the heel, foot, and elsewhere. In chronic gout sufferers (i.e. they’ve suffered gout for a number of years, probably a minimum of five) the pain may fly around joints of the foot as if it was on a tour of your foot before ending, or tripping off to another area. "Flying" pain is a sign of gout. Gout pain may also move more slowly around a typical gouty area, or to another one, but this can happen for non-gout heel conditions too.
Achilles tendon bursitis
The Achilles tendon runs from the heel bone to the calf muscles, in fact it holds them together. Between the Achilles tendon and the heel bone is a cushioning sac, the bursa. When this gets inflamed the condition is called bursitis. It causes a red, warm swelling at the back of the heel, just like gout. What inflames it? Strains on the Achilles tendon, arthritis in the heel, gout crystals and other causes.
Gout and bursitis
Bursitis can also look like gout. Gout crystals can get into the bursa, inflame it, and make it painful. Gout crystals are likely to make it more inflamed than otherwise would be the case, which is one way an experienced doctor can tell. And it's possible for a doctor to get the crystals out of bursa to find out if they are gout crystals, the procedure called joint aspiration or arthrocentesis, described above.
And a second bursa may develop in the area between the Achilles tendon and the skin, if the first becomes inflamed, or the first "inside" bursa may swell around the Achilles tendon, towards the skin. Taking pressure off the bursa with heel pads in the shoe, or padding around the bursa, can help. If it does, it's not gout either.