Gout in Heel - Symptoms, Diagnosis and, Treatment

Introduction

Gout is a kind of inflammatory arthritis that can lead to joint discomfort and swelling. It happens in reaction to the buildup of monosodium monohydrate (uric acid) crystals in joints, soft tissues, and bones, which is the result of human purine metabolism. Purines are the building blocks of DNA (deoxyribonucleic acid) and RNA (ribonucleic acid). The most prevalent natural antioxidant in the human body is uric acid. Even at physiologically normal levels, uric acid can be found in the less soluble form in acidic fluids like urine. Therefore, renal excretion controls the body's pool of urate. The genetic absence of the uricase enzyme, which eliminates uric acid, the reabsorption of 90 % of filtered uric acid, and the limited solubility of MSU (midstream specimen of urine) and urate in body fluids can all contribute to the development of hyperuricemia, which can then promote the nucleation and growth of monosodium urate crystals. Additionally, the cause of increasing serum uric acid levels is due to uric acid overproduction or underexcretion. Both primary or idiopathic and secondary hyperuricemia is possible. Overproduction may be brought on by conditions such as acute leukemia, tumor lysis syndrome, psoriasis, and toxic situations.

When plasma or serum urate concentrations are greater than 6.8 mg/dL, it is considered to have gout. Clinical signs of gout include acute gout flares (recurrent inflammatory arthritis flare-ups), chronic gouty arthropathy, tophaceous gout (accumulation of urate crystals), uric acid nephrolithiasis, and impaired renal function (chronic nephropathy).

What Is Gout in Heel?

The initial assumption while experiencing heel discomfort may be a condition like plantar fasciitis, which frequently affects this region of the body. Gout is still another option. Even though the big toe is where gout pain typically manifests, it can also be detected in other places, such as the heel.

What Are the Causes of Gout in Heel?

So why does gout affect the foot more than other regions of the body? As temperatures drop, uric acid becomes extremely sensitive. Liquid uric acid flows throughout the body and crystallizes in the feet (which are farthest from the heart and often the coldest), where it causes discomfort in the big toe or heel. When the body breaks down purines, the levels of uric acid increase. Foods like red meat and alcohol, as well as some drugs and the human body itself, all contain purines (especially as fat stores increase).

The majority of the time, the body can properly control uric acid levels by releasing the acid into the kidneys, where it is expelled as urine. However, if uric acid levels get to a certain point, the kidneys may find it difficult to function, and uric acid may remain in circulation where it crystallizes in the joints of the foot and causes swelling, discomfort, and inflammation.

What Are the Signs and Symptoms of Gout in Heel?

Signs and symptoms include the following:

• Prominent redness, swelling, and discomfort.

• Gout attacks in the middle of the night.

• The heel will be warm and painful to touch during a flare-up and even wearing socks will be agonizing.

• Following a gout attack, there may be discomfort that is less severe but persists.

• Unable to move the heel.

What Are the Risk Factors of Gout in Heel?

The risks factors of gout in heel include:

• Hyperuricemia - Enhanced level of uric acid in the blood.

• Purine Diet - Consuming animal products like red meat, organ meats like the liver and kidney, and shellfish like shrimp and lobster are dietary sources that can cause hyperuricemia and gout.

• Alcohol, sweetened beverages, sodas, and beverages containing high-fructose corn syrup are all possible risk factors for this condition.

• Increased lifestyle changes like increased protein consumption and a sedentary lifestyle.

• Older age.

• Male sex.

• Obesity.

• Medications - Diuretics, low-dose Aspirin, Ethambutol, Pyrazinamide, and Cyclosporine,

• Comorbid Diseases - Hypertension, diabetes mellitus, hyperlipidemia, and metabolic syndrome.

• Genetics.

• Stress can also act as a trigger.

How Is Gout in Heel Diagnosed?

• Synovial Fluid Analysis - Arthrocentesis is required to confirm the diagnosis and rule out other conditions including lyme disease, septic arthritis, or pseudogout (calcium pyrophosphate), as well as to determine whether uric acid crystals are present in synovial fluid taken from the afflicted joints.

• Laboratory Study - Even while an increased serum urate level (>6.8 mg/dL) might support the diagnosis, the white blood cell count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) serum urate levels may be high, normal, or low. Two weeks or more after a gout flare has totally subsided is the optimal window for measuring blood urate levels in order to establish a baseline value.

• Urine Analysis - The measure of uric acid excretion in urine.

• Ultrasonography - On ultrasonography, the presence of monosodium urate will be seen as a hyperechoic enhancement over the cartilage.

How Is Gout in Heel Treated?

For Acute Gout Flare: It is advisable to use symptomatic therapies including rest and the topical use of cold packs together with anti-inflammatory drugs. Nonsteroidal anti-inflammatory medications (NSAIDs), Colchicine, or systemic glucocorticoids is the first-line therapy for gout flare-ups. The therapies should last at least 7 to 10 days to avoid rebound flare-ups.

• NSAIDs - Ibuprofen, Naproxen, Meloxicam, Indomethacin, and Diclofenac. It is suggested not to take NSAIDs if one has a duodenal or gastric ulcer that is still active, cardiovascular disease (uncontrolled hypertension or heart failure), an NSAID allergy, or chronic renal disease.

• Oral Glucocorticoids - Prednisolone, Triamcinolone, or Methylprednisolone are examples of glucocorticoids that are advised for those who cannot use NSAIDs. In the joints or intra-articularly, glucocorticoids can be given. If the patients are unable to take intra-articular glucocorticoids, intramuscular or intravenous glucocorticoids are indicated. To reduce side effects, glucocorticoids should not be used frequently or repeatedly.

• Colchicine - If administered within 24 hours, Colchicine has been demonstrated to be efficient and minimize discomfort. It is a commonly given drug to relieve gout pain but has serious side effects like nausea and diarrhea. Most likely, the doctor will advise the bare minimum dosage.

For Non-acute Flares:

• Allopurinol - Lowers serum urate. Allopurinol does have certain negative side effects, including the potential to cause severe cutaneous adverse reactions, leukopenia, thrombocytopenia, and gout flare-ups.

• Uricosuric Drugs - Probenecid and Lesinurad.

What Are the Complications of Gout in Heel?

The complications of gout in heel include:

• Joint deformity.

• Osteoarthritis.

• Bone loss.

• Urate nephropathy.

• Nephrolithiasis.

• Due to the precipitation of uric acid crystals, gout may also result in eye problems such as conjunctivitis, uveitis, or scleritis.

How to Prevent Gout in Heels?

Changing one's lifestyle to reduce the risk of future attacks, such as by abstaining from alcohol, restricting intake of foods high in purines, such as meat, shellfish, high fructose corn syrup, and sweetened soft drinks, and switching to dairy products with lower or no fat content, one may prevent gout in the heel. Regular hydration and weight loss will also lessen the frequency of gout flare-ups.

Conclusion

One of the most painful conditions is gout and the most uncommon site for its occurrence is in the heel causing pain, swelling, and redness. Gout is caused due to formation of uric acid crystals in the joint, soft tissue, and bones. However, it can be treated and prevented effectively through medications by the healthcare provider.