Most of the time gout affects the first metatarsophalangeal joint (big toe) joint of the foot and the diagnosis is usually obvious. However, gout can affect any joint. As its not common in these other joints it may take some time to reach the diagnosis. Gout can also affect the heel, but affecting the subtalar joint and also the urate crystals can deposit around the plantar heel and mimic plantar fasciitis. Suspected gout in the heel can be treated initially with colchicine to help with the diagnosis.

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Why does gout affect mostly the first metatarsophangeal joint? No one really knows for sure, but there are several possibilities:
1.       The joint is further away from core body temperature than other joints, so the temperature of the joint is lower. This may affect the crystallisation of the uric acid.
2.       The pH of this joint is lower and may also affect the crystallisation of uric acid
3.       The first MPJ is subject to more trauma (on average) than other joint and this may predispose to it getting gout.

See: Latest on Gout; Gout Forum; ask a question about your gout

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