This patient has presented with concerns about painful bunions.
He also suffers from gout. On questioning, he has been less than conscientious with his taking of gout prophylactic medications.
On the clinical images on the left, he does look as though he has bunions, plus he has painful 1st MTPJs that could be associated with the abnormal articulation that can result from hallux abducto valgus.
On radiographic assessment, however, it can be noted that his intermetatarsal and hallux abductus angles are within normal limits. What can be seen is the grey shadowing around the joint that would be signs of tophi or tophaceous deposits. He also has a painful deposit on the lateral styloid process.
He feels he has exhausted non-surgical options and was keen to discuss surgery. He actually came in to discuss bunion surgery. He does not have bunions, yet once he has assessed the risks and benefits of the surgery, he could have the tophaceous deposits surgically removed. It is laid down and impregnated throughout the joint capsule and can be carefully cleared out. 100% of the tophi cannot be removed; however, marked debulking can eventuate.
I have reminded him he must be more diligent with his regular allopurinol medication as the condition can return.
If you have any specific questions or would like to discuss similar cases, feel free to contact me.
Also read:
Juvenile hallux valgus (bunion)
Gout or degenerative osteoarthrosis/hallux limitus?
Gout
Remember functional anatomy and to x-ray
(This content is intended for healthcare professionals only)