Does Gout (Uric Acid) Cause Pain in Heel

Gouty arthritis, much familiar called ‘gout’, occurs when there is a lot of uric acid (higher than normal) in the body. As with most arthritis, it is a painful condition affecting joints of the body. The metatarsal-phalangeal joint located at the base of the big toe is the frequent area affected by this arthritis. Sometimes gout occurs in the knees, ankles, wrists, fingers, and elbow. Does it also attack the heel and cause heel pain?

First off, heel pain has many causes

It’s an extremely common foot problem, probably in women. The pain can occur in the side, under, or just behind the heel. Although it’s very common, it’s not always easy to find the underlying cause of the problem since there are a number of different potential causes (ranging from mild to serious), some are as follows [1].

Plantar fasciitis and Achilles tendonitis

Although pain in the heel can be attributed by many factors, the most common causes probably are plantar fasciitis and Achilles tendonitis.

Plantar fasciitis, as the name suggests, is inflammation and irritation of the plantar fascia (the tight tissue, bowstring-like ligament that connects the heel bone (calcaneum) and the base of toes). It causes pain in the heel, which typically will flare up after rest (e.g. after prolonged sitting or when you make first steps in the morning). Obesity and certain exercises that drive a lot of pressure on the heel would make plantar fasciitis more likely.

How about Achilles tendonitis? This chronic and degenerative tendonitis affects the Achilles tendon, a strong and large tendon located in the back of the heel bone. It causes inflammation and swelling, making your heel painful with movement. The affected tendon is usually stiff in the morning. Many times Achilles tendonitis is a result of overuse, running too much for example.

Heel bumps and bursitis

Also called pump bumps, heel bumps often affect teenagers since their heel bone is still fragile (not fully mature). It causes the formation of too much bone, which is quite painful. Teenagers who start to use high heels when their heel bone is not ready enough would be at high risk of this syndrome.

Heel bursitis is inflammation affecting the bursa, a fibrous fluid-filled sac. Depending on where the inflammation occurs (the bursa located beneath the Achilles tendon or the bursa between the skin and Achilles tendon), the pain would be deep in the back of your heel or felt on top of your Achilles tendon. Excess pressure from footwear and landing awkwardly are some common causes of heel bursitis.

Stress Fractures

Repetitive stress from activities, strenuous exercise and competitive sports for examples, drives more excess stress on the heel bone which may lead to a fracture. That’s why stress fractures are quite common in athletes especially long distance runners.

Runners are at high risk of developing stress fracture affecting their metatarsal bones of foot. Certain conditions such as eating disorder (like anorexia) and chronic bone-loss disorder (osteoporosis and osteopenia) will also make the fracture more likely.

The fracture is painful, which may interfere with daily activities. Generally speaking, the pain often worsens with activity, and t it usually subsides with rest. The affected area may also become swollen and tender.

Tarsal tunnel syndrome

This nerve condition primarily affects the large nerve located in the back of the foot. It occurs when the nerve get pinched or compressed (entrapped), causing painful sensation (aching /burning) that may also be felt elsewhere.

Although the pain is commonly felt near the toes or/and in the bottom of your foot, sometimes you may feel the pain in the heel. The pinched nerve may also cause numbness and tingling similar those of carpal tunnel syndrome (a nerve condition that occurs in the hand). The symptoms often get worse at night.

What else?

Again, there are many causes that can factor into heel pain. Here are a few other examples.

  1. Heel pad syndrome, a condition in which the fat pad of the heel gets thinning. This could be a consequence of obesity and trauma (consistent pounding from running marathon, for example). It may causes pain, typically felt in the center of the heel. The pain gets worse if you do weight-bearing activity.
  2. Fat pad atrophy. As the name implies, it occurs when the fat pad of the heel is breakdown (atrophy). When the cushioning fat of the heel doesn’t work as well, your heel is more likely to become painful with activity during the day.
  3. Sever’s disease, which is usually found in children or teenage athletes. This bone injury occurs when the growth plate of the heel bone, located in the lower back of the heel, becomes inflamed.
  4. Sinus tarsi syndrome. A condition of when a small bonny tube (the space on the outer side of your foot between the heel bone and ankle), also called ‘sinus tarsi’, becomes injured or damaged. A personal history of ankle problem especially inversion ankle sprain may have a role to increase the risk.

Poor posture, bone bruise, calcaneal cysts, Achilles tendon rupture, and infection might also factor into heel pain. How about gout?

Gout and pain in the heel

Gout is not always easy to understand, though it’s common. It is a complex type of arthritis. It can attack anyone, but some factors may make this painful arthritis more likely. These include [2]:

  1. Lifestyle factors such as; poor diet (especially diet high in purines) and obesity.
  2. Certain medications may cause an increase in uric acid levels, such as; thiazide diuretics and aspirin.
  3. Certain medical conditions, such as; chronic metabolic syndrome, diabetes, untreated hypertension, kidney and heart problems.
  4. A family history of the same condition. If you have a family member who has had gout, you’re also at high risk to develop one as well.
  5. Age, gender, and trauma from surgery might also have an effect to increase the risk.

The amounts of uric acid, derived from purines, increases for several reasons. But in general, it occurs when the body makes too much uric acid (from high-purine diet and obesity, for examples) or if there is something wrong with the mechanism of the body to get rid of excess uric acid (such as in people with kidney disease).

Over time, excess uric acid can accumulate and build up somewhere in the body, resulting in sharp & needlelike crystals. The urate crystals that accumulate in the joint and its surrounding structures can cause inflammation, swelling, and pain.

The needlelike crystals are likely to accumulate in the large joint of the big toe, probably due to gravity. Therefore, gout is often found in the big toe. Joints of knees, ankles, wrists, elbow, and fingers are other commonly affected sites [3]. How about the heel?

In rare cases, gout might affect the heel and cause heel pain. But heel pain is not specific symptom of gout and again it can be attributed by many factors.

Since gout is not the leading cause of heel pain, some doctors probably are looking for other causes than gout. But if you have had experience a gout attack, your heel pain is probably caused by gout and your doctor would suggest a few tests such as joint fluid and blood tests.

Gout symptoms may vary from person to person. The kind of your gout (whether it’s acute or chronic) also has a role. Some of the common symptoms include:

  1. Intense joint pain that can strike suddenly (particularly true for acute gout). The most intensity period of the pain is usually the first 60 minutes to 12 hours after the flare-up.
  2. The affected joint becomes inflamed and swollen, which may also be followed with joint redness and warmth.
  3. Morning stiffness. The affected joint can be very stiff with limited range of motion or probably painful to move after a prolonged period of inactivity.
  4. Gout may also cause vogue symptoms such as fever and fatigue.

The disease may cause lingering discomfort. Discomforts in the affected joint may still last for several days or weeks after the most intense & severe pain subsides.

Gout is a chronic condition. It must be monitored and controlled as well to prevent further damage and other serious complications. If poorly controlled, the attack may return to affect more joints and last longer.

Whether or not your heel pain has to do with gout, it’s worth a try to find out the exact cause of the problem. If the pain persists (doesn’t improve more than 1-2 days or last longer than a week), see a doctor!

Resources:
  1. Heel Pain, American Academy of Orthopedic Surgeons (2017)
  2. Gout, (2010) Richette, P. and Barden, T.
  3. Heel pain, American College of Foot and Ankle surgeons. Retrieved from this URL.