Does Foot Ache Always Mean Gout?

Whenever people get foot ache, especially a swollen foot, they often ask if it is gout.

If you suspect gout, your first call should be to your doctor. If it is not gout, then something may be causing physical trauma, and the sooner you get this seen by an expert, the better. If it is gout, then the sooner you start uric acid lowering treatment, the less chance you have of developing chronic gout, which destroys your quality of life as it destroys your joints.

Diagnosing Foot Ache

Your doctor is likely to ask if you recall any physical trauma. Accidents and injuries are the most common cause of foot ache. Your doctor will also assess your medical history, ask about family medical history, and physically inspect your feet.

This type of investigation is vital, so you must see your doctor, and not rely on information you pickup online or from friends. There are many causes of foot problems and swollen joints. The swelling is an indication that something is wrong, but gout is only one of many diseases that cause inflammation and swelling.

Diagnosing Gout

Many guidelines have been published to help doctors differentiate between gout and other diseases that cause aching feet and swollen joints. The most current recommendations are from professional advice issued by leading American Rheumatologists, modified from European standards. I have modified some of the language to suit laypeople, and linked the original text below[1].

Your doctor should be aware of the recommendations, so please feel free to refer him to the full text, which is written with healthcare professionals in mind.

EuLAR Recommendations for Gout Diagnosis (Modified to US Standards)

  • Crystal arthritis includes gout, pseudogout and inflammation from other types of crystals. These usually cause pain, swelling and tenderness that develops rapidly, peaking in 6 to 12 hours. Though this is highly suggestive of crystal arthritis, it may be something other than gout. If suspected, examination of joint fluid is recommended, as treatments are different for gout which is caused by uric acid crystals.
  • If joints affected are typical, such as feet, then gout is the most likely, but not definite.
  • Gout can include lumps under the skin (called tophi) as well as swollen joints. If examination of tophi or joint fluid reveals uric acid crystals, then gout is confirmed.
  • Uric acid crystals may be present in joints that do not show symptoms of gout.
  • Gout can coexist with septic arthritis, therefore it is important to test for both.
  • Although important, uric acid levels from blood tests do not confirm or exclude gout. Some people have high uric acid, yet do not develop gout. Some gout sufferers show normal levels during acute gout flares, as uric acid moves from the blood into the joints and other tissues.

Diagnosing Foot Ache: Next Steps

As you can see, diagnosing gout is not always straightforward. That is why it is important to seek professional medical attention at the first signs of unexplained aching feet or swollen joints. Usually your family doctor can handle this, but if your case is complicated, it is best to seek a rheumatologist who is experienced in diagnosing and treating gout. If you need specific help with what to ask, or how to understand what your doctor has told you, please see the gout symptoms forum.


Diagnosing Foot Ache: References

  1. Title: Core Principles in the Diagnosis and Management of Gout and Hyperuricemia. Authors: Schumacher HR, Weaver AL. File: Gout And Hyperuricemia

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