Gout is a type of arthritis caused by a buildup of uric acid and characterized by foot pain, swelling, redness, and difficulty walking is typically localized in the big toe. However, some types of gout may be localized in the heel, making it difficult to distinguish from plantar fasciitis.
Let’s explore the connection between gout and heel pain, as well as symptoms that can help you tell the difference between plantar fasciitis and gout
The Connection Between Heel Pain and Gout
While it’s fairly rare for gout pain to appear in the heel (instead of near the big toe), it does happen!
Gout that leads to foot pain develops when there are high levels of uric acid in the body. And high levels of uric acid are most likely to develop under the following conditions:
- Diet: A diet that is heavily focused on red meat, sugar (particularly fructose), and alcohol (beer, in particular) can increase levels of uric acid and gout.
- Increase in body fat: As your body increases its stores of body fat, uric acid levels rise, and your kidneys may struggle to eliminate the excess.
- Medications: Some medications, including hypertension, may increase uric acid in the body. Studies show that Thiazide diuretics (which treat hypertension) are key culprits.
- Untreated medical conditions: High blood pressure, metabolic syndrome, diabetes, and kidney disease can all contribute to higher than usual levels of uric acid in the body, and gout.
- Genetics and gender: There is a genetic link to gout. If you have a family history of gout, you may be especially susceptible. Younger men are more likely to get gout than women; however, postmenopausal women have an increased risk as well.
How Can High Uric Acid Cause Heel Pain?
So, why does gout show up in the feet (as opposed to other body parts)? Uric acid is very sensitive to cooler temperatures. As it circulates throughout the body and reaches the feet (furthest from the heart and typically the coolest), the liquid uric acid crystalizes, leading to pain in the joints of the big toe or joint of the heel (where the heel bone meets the ankle bone).
Uric acid levels rise when your body breaks down “purines.” Purines are found in foods like red meat and alcohol, as well as in certain medications and naturally in the human body (especially as fat stores increase).
Most of the time, your body is able to manage uric acid levels effectively, simply dumping the uric acid into your kidneys where it is excreted as urine. However, when uric acid levels get high enough, your kidneys may struggle to keep up, and uric acid may stay in your bloodstream where it causes inflammation, pain, and swelling as it crystallizes in the joints of the foot.
Is My Heel Pain Gout or Plantar Fasciitis?
Heel pain can be confusing at times. While the most common cause of heel pain is plantar fasciitis, other less common ailments like gout can mimic similar symptoms! Use this helpful symptom guide to determine whether you’re dealing with plantar fasciitis or gout:
Symptoms of Heel Pain from Plantar Fasciitis
The hallmark symptoms of plantar fasciitis include the following:
- Heel pain that’s most intense first thing in the morning (when the plantar fascia hasn’t “warmed up” yet through movement).
- Pain that improves somewhat with stretching and low-impact physical activity
- Sharp or dull pain, accompanied by redness or swelling
- Pain that coincides with weight gain
- Difficulty walking or standing on the affected foot (plantar fasciitis can happen in both feet, though more rarely!)
- Pain that improves through the use of orthotics that help properly realign and cushion the plantar fascia
Symptoms of Heel Pain Due to Uric Acid
Anyone can get gout, although it’s most common in individuals with the risk factors we covered earlier (like heavy alcohol use, or a diet that includes a lot of red meat.) The symptoms of gout in the heel are subtly different from those of plantar fasciitis in the heel:
- Redness, swelling and tenderness that is most pronounced where the heel meets the ankle. You are also likely to notice symptoms at the base of the big toe.
- Often, gout symptoms will flare-up in the middle of the night (when that uric acid settles and cools during this period of low activity)
- During a flare-up, your heel will feel so hot and painful to the touch that even wearing socks is excruciating
- Pain that is less intense but lingers after a “gout attack” flare-up of pain
- Increasing difficulty moving the joint
As a general rule of thumb, pain from plantar fasciitis will improve with rest, while pain from gout will flare up during long periods of inactivity and rest.
Treating Heel Pain from Gout
Thankfully, most cases of heel pain from gout can be successfully resolved with minimal medical intervention and changes to diet and lifestyle.
NSAIDs (non-steroidal anti-inflammatory drugs) like Tylenol and Ibuprofen can help relieve pain from a gout attack, as well as reduce pain and swelling in the heel.
Colchicine is another common medication prescribed to treat pain from gout, however, it can cause severe side effects like nausea and diarrhea. Your doctor will likely recommend the minimal dose needed.
Corticosteroids are used in rare cases when NSAIDs or Colchicine can’t be taken since these drugs have serious side effects including high blood pressure and high blood sugar.
If you have ongoing gout attacks, or severe ongoing gout symptoms your doctor may also consider prescribing medication that limits the amount of uric acid your body produces.
Limit foods that increase uric acid production: These foods include alcohol, red meat, seafood, organ meats, fructose sugars, and other foods high in purines.
Exercise and manage weight when possible: As possible, maintain a healthy weight to keep the body’s own production of uric acid down.
Drink coffee: While scientists don’t understand the link completely, some studies have shown that drinking coffee can help lower your levels of uric acid!
Add more vitamin C to your diet: Taking at least 500 mg of vitamin C each day (and eating foods rich in vitamin C) has been shown to make a measurable, positive impact on uric acid levels in the body!
Have you suffered from heel pain that turned out to be gout? Tell us about your experience in the comments below!