Purpose: This study is to present a case of a patient experiencing foot pain after being prescribed capecitabine and to review the differential diagnosis between hand-foot syndrome and gout. Methods: This case is an 89-year-old patient endorsed to an emergency department with a 2-day history of foot swelling and pain. Results: The old patient was treated with capecitabine which was orally administered twice daily for 2 weeks, followed by 1 week of rest. He experienced severe pain in his foot area during the 3rd chemotherapy cycle. Side effects must be assessed to keep treatment on course. Conclusion: Clinical specialists should be knowledgeable of differential diagnosis.