Running With Gout - Beware Foot Tendon Damage

Recently, in the gout forum, we have discussed the problems of running on gouty feet.

Michael, in the Running and Gout discussion, complained:

Ever since I’ve been diagnosed with gout it’s been hard for me to run. […] It seems that every time I run on the treadmill or on the track, the next morning my gout will flare up.

Patrick, in Possible gout going over 3 months, asked:

I cannot walk without severe pain. […] Do you think the pain in my big toe is gout, even though the pain only occurs with exercise or long walk? […] Anyone else have similar pain after exercise?

To which Paul, in the same discussion, noted:

I developed some tendonitis in my left arm (likely triggered by overuse on the golf range). This tendinitis recently became more intense as time went on and recently, it came to a point that I could no longer move my arm without excruciating pain, particularity in the elbow and the thumb joints.

Having done some research, I am concluding that the tendonitis has evolved into a gout-related issue

Geoff, in Gout and tendonitis, said:

For years, I have also been very susceptible to tendonitis, especially in my elbows (both sides) and my Achilles tendon. Since my uric acid levels have come down, I have had far fewer tendon problems. I played tennis every day in July without any real pain. The year before, I could not hold a racquet after one day. So, there seems to be a beneficial correlation here.

I’ve written about the effects of gout crystals on tendons earlier. Gout causes joint damage because cells that should be repairing tendons, cartilage, and bone, end up fighting uric acid crystals. Unfortunately, the damage starts before we even know we have gout. DECT imaging shows uric acid deposits in parts of the body before we notice any painful gout symptoms.

Gouty Foot Image

Running with Gout Foot DECT Image — Gouty Foot DECT Image

In Tendon involvement in the feet of patients with gout: a dual-energy CT study, Nicola Dalbeth and colleagues investigated 92 gout patients. Only 12 of these patients were without uric acid crystal deposits in their feet. Of the 80 patients with gouty feet, the most affected part of the foot was the Achilles tendon. Usually, crystals are found at the point where the tendon attaches to the bone, but the entire tendon can be affected. Note that in the photograph, gout crystals are colored green, but this is artificial coloring from software so that the deposits can be seen more clearly.

Running On Gouty Feet

We can see that concerns about strenuous exercise with gout are justified. Because tendons and other parts of the feet are weakened by uric acid crystals. Si, in this state, they are more likely to be damaged by stressful exercise. Therefore, it is a good idea to discuss exercise with your doctor and a professional trainer. Then you can get an exercise plan that does not overstress your joints.

Of course, your best way forward is to get uric acid below 5 mg/dL. That will eventually lead to uric acid crystals dissolving, allowing your tendons to recommence the natural repair processes. Get your joints safe first, then exercise is no problem.

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Common Terms: big toe, foot, tendon