• 1

    Pineda C, Amezcua-Guerra LM, Solano C, et al: Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study. Arthritis Res Ther 13: R4, 2011.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 2

    Dalbeth N, Kalluru R, Aati O, et al: Tendon involvement in the feet of patients with gout: a dual-energy CT study. Ann Rheum Dis 72: 1545, 2013.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 3

    Pascual E, Addadi L, Andres M, et al: Mechanisms of crystal formation in gout: a structural approach. Nat Rev Rheumatol 11: 725, 2015.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 4

    Andia I, Abate M: Hyperuricemia in tendons. Adv Exp Med Biol 920: 123, 2016.

  • 5

    Lagoutaris ED, Adams HD, DiDomenico LA, et al: Longitudinal tears of both peroneal tendons associated with tophaceous gouty infiltration: a case report. J Foot Ankle Surg 44: 222, 2005.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Fairhurst RJ, Schwartz AM, Rozmaryn LM: Gouty tenosynovitis of the distal biceps tendon insertion complicated by partial rupture: first case and review of the literature. Hand 12: NP1, 2016.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Ottaviani S, Forien M, Dieude P: Achilles tendon enthesis with double contour sign revealing gout. Joint Bone Spine 84: 641, 2017.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 8

    Taniguchi Y, Matsumoto T, Tsugita M, et al: Spondylodiscitis and Achilles tendonitis due to gout. Mod Rheumatol 24: 1026, 2014.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 9

    Pittman JR, Bross MH: Diagnosis and management of gout. Am Fam Physician 59: 1799, 1999.

  • 10

    Rettenbacher T, Ennemoser S, Weirich H, et al: Diagnostic imaging of gout: comparison of high-resolution US versus conventional X-ray. Eur Radiol 18: 621, 2007.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 11

    Ryckaert T, Crevits I, Brijs S, et al: Pseudotumoral tophaceous involvement of the Achilles paratenon. Belg J Radiol 98: 34, 2015.

  • 12

    Fritz J, Heness JC, Fuld MK, et al: Dual-energy computed tomography of the knee, ankle and the foot: noninvasive diagnosis of gout and quantification of monosodium urate in tendons and ligaments. Semin Musculoskelet Radiol 20: 130, 2016.

    • Crossref
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 13

    Ventura-Rios L, Sanchez-Bringas G, Pineda C, et al. Tendon involvement in patients with gout: an ultrasound study of prevalence. Clin Rheumatol 35: 2039, 2016.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 14

    DeCarbo WT, Hyer CF: Interference screw fixation for flexor halluces longus tendon transfer for chronic Achilles tendonopathy. J Foot Ankle Surg 47: 69, 2008.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Mahoney PG, James PD, Howell CJ, et al: Spontaneous rupture of the Achilles tendon in a patient with gout. Ann Rheum Dis 40: 416, 1981.

  • 16

    Lockie LM: Symposium on gout; diagnosis. Metabolism 6: 269, 1957.

  • 17

    Levy M, Seelenfreund M, Maor P, et al: Bilateral spontaneous and simultaneous rupture of the quadriceps tendons in gout. J Bone Joint Surg Br 53: 510, 1971.

  • 18

    Lee K, Moon JS, Seo JG, et al: One-stage treatment of deep infection following repair of Achilles tendon rupture with flexor hallucis longus transfer. Knee Surg Sports Traumatol Arthrosc 17: 313, 2009.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation

Gouty Achilles Tendinopathy: A Case Report

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  • 1 Grant Medical Center, Columbus, OH.
  • | 2 Foot & Ankle Specialists of Central Ohio, Grant Medical Center, Newark, OH.
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Tendinopathy in the presence of gouty arthropathy is relatively common, yet the clinical suspicion for gout involvement in acute tendon pain remains low. A 49-year-old man presented with an acute, tender, erythematous mass to the right posterior heel. A computed tomographic scan was obtained, which revealed a septated fluid collection superficial to the Achilles tendon. The patient was taken to the operating room for an incision and drainage with debridement, and the abscess was found to be filled with caseous material. The diagnosis of gout was confirmed with pathology. The calcaneus was submitted to biopsy, and the results were negative for osteomyelitis. The patient was returned to the operating room for repair of the Achilles tendon with flexor hallucis longus tendon transfer. Postoperatively, the patient was nonweightbearing for 6 weeks. Oral colchicine was used perioperatively, and a steroid taper was administered. The patient was started on allopurinol and colchicine for chronic treatment. At 14 months, the patient was walking without pain or recurrence of the mass. Although the relationship between hyperuricemia and tendinopathy is not completely understood, it is apparent that tendon involvement may be a sequela in patients with gout. When a patient presents with acute tendon pain, gout should be considered in the differential diagnosis.

Corresponding author: Chandana Halaharvi, DPM, Grant Medical Center, 389 S Grant Ave, Apt B, Columbus, OH 43215. (E-mail: chalaharvi@gmail.com)