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Back of heel pain - Gout?

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ganesh80911
ganesh80911

For about a decade I have been suffering from heel pain. This condition is getting chronic as days goes by and there is still no firm diagnosis. I am Indian make, 47 (pain started 37).

It all started in a nice spring day in 2011. I went for a long bike ride and came back with a tender heel at the insertion of achilles tendon. The next day the pain was so acute, I was unable to move my feet. My doctor suggested anti inflammatory and I took ibuprofen for a couple of days. I have back to normal in about 5 days. This will become an yearly event, with episodes in the spring/summer time. I have systematically stopped hiking hills, running on pavement, running on an incline in treadmill, running and now even walking 10,000 steps.

The biggest turning point came in 2019, when I started to have pain that would take 4-6 weeks to be completely pain free. Blood work was done to check if it was Gout and uric aid levels were high but close to upper limit - 464 umol/L. Arthritis was rules out. MRI and ultrasound came back with insertional tendonitis and inflamed heel bursa.

The last two episodes came after mild activity, but not serious enough to cause tendonitis or bursitis. This is when I tuned to a doctor in India for a second opinion. All Canadian doctors did their best (and I thank them for that) but could not isolate my pain to a cause after 10 years.

The doctor in India suggested it was uric acid and asked me to try a low purine diet. I am doing that now.

Here are my symptoms

  1. Tender at achilles insertion always on the lateral side

  2. Pain while pressing on tendon , but not so much when foot is in full dorsiflexion (initial stages)

  3. At the peak of the pain, while walking, plantarflexion causes EXCRUCIATING pain. I can compare it to post surgical pain

  4. icing helps. Naproxen seems to help more than ibuprofen

I have orthotics, strengthened my calf but nothing seems to help.

I also went on statin 10 years ago. I am not sure if there is a connection, but it is highly co-incidental.

Is it really gout? can gout cause inflamed bursa and insertion tendenitis?

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