Atypical Presentation of Gout: Idiopathic Retrocalcaneal Pain in 400 Patients
Journal of Clinical Orthopaedics | Vol 9 | Issue 2 | July-December 2024 | page: 58-62 | Shivam Mehra, Nindiya Kapoor Mehra, Arvind J. Vatkar, Kamal Mehra, Bharat Veer Manchanda, Sachin Kale
DOI: https://doi.org/10.13107/jcorth.2024.v09i02.666
Submitted Date: 05 Aug 2024, Review Date: 25 Aug 2024, Accepted Date: 11 Oct 2024 & Published Date: 10 Dec 2024
Author: Shivam Mehra [1], Nindiya Kapoor Mehra [1], Arvind J. Vatkar [2], Kamal Mehra [1], Bharat Veer Manchanda [3], Sachin Kale [4]
[1] Mehra Hospital and Research Institute, Lucknow, Uttar Pradesh, India,
[2] MGM Medical College, Nerul, Navi Mumbai, Maharashtra, India,
[3] Arthritis and Breast Care Centre, Kurukshetra, Haryana, India,
[4] Department of Orthopaedics, Dr D Y Patil School of Medicine, Nerul, Navi Mumbai, India
Address of Correspondence
Dr. Shivam Mehra,
Mehra Hospital and Research Institute, Lucknow – 226012, Uttar Pradesh, India.
E-mail: drshivammehra@gmail.com
Abstract
Introduction: Idiopathic retrocalcaneal pain is frequently linked to overuse injuries or inflammation around the Achilles tendon and surrounding bursae. However, systemic conditions such as gout, characterized by monosodium urate crystal deposition, can also present as retrocalcaneal pain. Gout commonly affects the first metatarsophalangeal joint, but atypical presentations like retrocalcaneal involvement are increasingly recognized. This study aims to assess the presentation, diagnosis, and treatment outcomes of gout in patients presenting with idiopathic retrocalcaneal pain.
Materials and Methods: This retrospective study analysed clinical data from 400 patients diagnosed with gout and presenting with idiopathic retrocalcaneal pain between 2019 and 2023 at a tertiary care centre. Diagnosis was based on clinical examination, serum uric acid levels, imaging, and in some cases, synovial fluid analysis. Patient demographics, diagnostic methods, and treatment outcomes, including pain (VAS) and functionality (FADI) scores, were evaluated.
Results: Of the 400 patients, 290 (72.5%) were male, and 110 (27.5%) were female, with a mean age of 56.8 ± 12.3 years. Pre-existing gout was present in 58% of patients, and serum uric acid levels were elevated in 75%. Synovial fluid analysis, performed in 65 patients, confirmed monosodium urate crystals in 92.3% of cases. Treatment resulted in significant reductions in pain (VAS: 7.8 ± 1.4 to 3.2 ± 1.1, p < 0.05) and improved functionality (FADI: 58.4 ± 5.7 to 85.7 ± 6.3). Recurrence of symptoms occurred in 25% of patients, particularly in those who did not adhere to urate-lowering therapy.
Conclusion: This study emphasizes the importance of considering gout in the differential diagnosis of idiopathic retrocalcaneal pain. Early diagnosis and appropriate management can lead to favourable outcomes and lower recurrence rates. Clinicians should remain vigilant for atypical presentations of gout to prevent prolonged discomfort and functional impairment.
Keywords: Idiopathic retrocalcaneal pain, gout, hyperuricemia, monosodium urate crystals, Achilles tendon, atypical gout, urate-lowering therapy
References
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| How to Cite this article: Mehra S, Mehra NK, Vatkar AJ, Mehra K, Manchanda BV, Kale S. Atypical Presentation of Gout: Idiopathic Retrocalcaneal Pain in 400 Patients. Journal of Clinical Orthopaedics July-December 2024;9(2):58-62. |
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