Please Heel Me, I Can't Walk!

A previously healthy 20-year-old man presented to the emergency department with difficulty walking and bilateral heel pain. His pain started acutely in the right heel approximately 3 months prior to presentation with no known trauma or injury. He had previously been treated with steroids for presumed tendinitis and magnetic resonance imaging of his ankle showed a possible partial tear of the right Achilles tendon. His pain worsened and involved swelling of both heels so that he was unable to walk. On presentation, he had a normal neurological exam. His musculoskeletal exam was pertinent for pain over the calcaneus bilaterally and swelling with firmness over both Achilles tendons. Labs were notable for an elevated uric acid, and a computed tomographic scan of his feet showed the presence of monosodium urate crystal deposition, consistent with a diagnosis of gouty arthritis. Despite gout being a disease diagnosed almost exclusively in adults, pediatric providers must consider this and other diseases that typically affect adults, especially when treating patients at the older end of the pediatric spectrum.