Heel gout. More about diagnosing it

This page, heel gout page 2, was last reviewed, or updated, on 29 January  2018

Visit heel gout page 1, our first page about diagnosing gout in the heel


Tendonitis is not gout

This website has heard from a gout sufferer whose gout was originally diagnosed as tendonitis. Achilles tendonitis (tendinopathy) is inflammation of the Achilles tendon, which causes heel pain and maybe heel swelling.

Heel spurs are not gout  

A heel spur is the growth of additional  bone in the heel. Heel cushion pads or larger rectifying shoe insoles often work. Spurs can cause bursitis – an inflamed cushioning sac found in the heel which can look like gout in the bursa  They usually clear up without surgery, but if they don’t surgery is needed. Their pain is likely to be most during the morning's first steps, unlike gout pain. 

Other heel pains which are not gout 

Heel pain could simply be from a broken bone, a sprain, or arthritis. 

Of course diagnosis gets harder if gout co-exists with any other heel or foot pain condition. This isn't common, but it can happen.

Pseudo gout is not gout

Trouble-causing crystals may be the crystals of pseudo gout - calcium pyrophosphate dehydrate crystals. These kinds of crystals can get into all the places that gout's MSU crystals do, but this is  a different disease; for example it builds up less quickly than gout. And unlike gout's crystals these ones can be seen by an X ray machine, or other scanning equipment. They certainly look different under the polarising (polarizing) microscope used for the definitive gout diagnosis.

Read more about the difference between gout and pseudo gout here.


When, in 1679, Antoni van Leeuwenhoek in Holland acquired a lump of a tophus to examine though his state-of-the-art microscope, the tophi he examined had actually poured out of a relative's heel. Van Leeuwenhoek saw that a tophus consists of accumulated crystals. It was the first accurate understanding of a gout symptom, related to the true cause of gout – an excess of uric acid.  

And from the way this event has been described, it seems that oodles of the stuff came out of the heel. Since it poured out, its consistency was probably like toothpaste or cottage cheese, mixed with pus. At a later stage in the heel, it will harden.

Tophi that has been resident in a gouty heel for some time, probably under the sole of the heel, can stretch and thin the skin so that it might burst the skin and come out of it quite easily. This happens today with tophi in the ear’s ridges, and occasionally it does happen with heels. It would occur at the chronic stage of gout, after gout has been in the body without successful treatment, for around five years or more, and leave behind an open sore which would need treatment.

If the subtalar joint in the heel is repeatedly attacked, tophi will develop here from accumulated crystals and it could both get into the adjacent bones and erode them from outside. Eventually it might break them. Tophi can also be deposited on the Achilles tendon maybe causing a slight bulge on the skin but it's not common. And break it too. All of this of course, if treatment hasn’t been successful.

Tophi diagnosis is much easier since it can be seen by scanning equipment but a tophi diagnosis is a late gout diagnosis. However, if it happens, better late than never.


If you have read heel gout page 1 you will probably have realized that if you can, try to see an experienced rheumatologist about it.  A rheumatologist who has the necessary polarising (polarizing) microscope with a compensator for it, on the premises, which s/he often uses.

But in the case of gout in any part of the foot, and to distinguish it from other kinds of foot problems, a podiatrist may also have a lot of experience of gout in the foot.

To avoid unnecessary repetition here, to read about treatment for heel gout, visit the
wrist gout page and read the section What can you do about wrist gout pain? With gout, what applies to the wrist, applies to the heel. 

Just one difference is that a raised heel may help pain relief.

Gouty heel pain relief There is no specific medicine for just gout pain in the heel.  Gout medicines are only for relief for gout pain, wherever the pain is in the body. The methods of dealing with the pain, medications and natural, are on the wrist page. Similarly, the long term heel gout treatment is to reduce the serum (blood) uric acid level, as it is with gout anywhere in the body.

You may be able to find gout creams that provide some relief. Bathing the feet in warm water to which Epsom salts have been added might bring some relief.

Visit our first page about heel gout


Go to our index page for all our gout in different body areas pages, and find out what gout is like in different places.

Read about footwear for gout on our shoes for gout page.

Hip gout can be hard to diagnose, so here's what you must do.

Read about what gout can do to the wrist - wrist gout page 1

And read about diagnosing wrist gout and how to deal with wrist gout pain - wrist gout page 2

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