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Q&A
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Is pain in the calf muscles, heel and toe due to gout?

Thursday, 02 March 2006
Answered by: Professor Anand N. Malaviya
Consultant Rheumatologist,
A & R Clinic,
New Delhi

Q. About four months back, I developed sudden ankle pain in the left leg, which lasted for two days. A month later, I felt as though the nerves in the sole of my left foot were pulling and by afternoon, I had severe pain in the big toe. After this, a month later, a similar thing happened in my right leg. All three episodes happened after running 3 to 5 km. My uric acid level was 7.9 mg/dl (now it is 5.9). It was diagnosed as Gout, so I am having allupurinol. I continue to get pain in the calf muscles, heel and toe of both legs including nerve pulling in the soles of my feet. I have some pain in the lower back too and whenever there is strain on my back, I get pain in the calf muscles, heel and toe too. Can gout cause continuos pain in both legs and feet? Is it possible that I am actually suffering from something else such as a referred pain from lower back or a problem in Achilles tendons due to running?

A.  Going through your history, I feel that there is a very high chance that you have a condition called spondyloarthritis, a very common condition seen in about 1-2% of the population occurring in young males usually starting below 40 years of age. This disease is not well known to Orthopaedic surgeons and very often they confuse it with gout, which is an uncommon condition to start below the age of 40 years. Moreover, such episodes with lower back pain cannot occur in gout. Under these circumstances I strongly recommend that you immediately see a Rheumatologist (a physician specialising in joint diseases, NOT an Orthopaedic surgeon!). In Delhi the list of rheumatologist is as follows: All India Institute of Medical Sciences: Dr. Ashok Kumar, Dr. R. Handa, Dr. R. K. Gupta and Dr. Uma Kumar. – Adult rheumatologists Sir Ganga Ram Hospital: Dr. Lalit Duggal, Dr. Atul Kakkar – Adult rheumatologist. Apollo Hospital: Dr. S. J. Gupta – Adult rheumatologist Dr. Sundeep Upadhyaya - Adult Rheumatologist. Indian Spinal Injuries Centre (Vasant Kunj): Dr. Sanjiv Kapoor - Adult rheumatologist Dr. A. N. Malaviya - Adult rheumatologist You may like to consult any of these doctors to get your ailment properly diagnosed and treated.

A.  Going through your history, I feel that there is a very high chance that you have a condition called spondyloarthritis, a very common condition seen in about 1-2% of the population occurring in young males usually starting below 40 years of age. This disease is not well known to Orthopaedic surgeons and very often they confuse it with gout, which is an uncommon condition to start below the age of 40 years. Moreover, such episodes with lower back pain cannot occur in gout. Under these circumstances I strongly recommend that you immediately see a Rheumatologist (a physician specialising in joint diseases, NOT an Orthopaedic surgeon!). In Delhi the list of rheumatologist is as follows: All India Institute of Medical Sciences: Dr. Ashok Kumar, Dr. R. Handa, Dr. R. K. Gupta and Dr. Uma Kumar. – Adult rheumatologists Sir Ganga Ram Hospital: Dr. Lalit Duggal, Dr. Atul Kakkar – Adult rheumatologist. Apollo Hospital: Dr. S. J. Gupta – Adult rheumatologist Dr. Sundeep Upadhyaya - Adult Rheumatologist. Indian Spinal Injuries Centre (Vasant Kunj): Dr. Sanjiv Kapoor - Adult rheumatologist Dr. A. N. Malaviya - Adult rheumatologist You may like to consult any of these doctors to get your ailment properly diagnosed and treated.

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