I have carried out surgery on three patients recently who have had moderate bunions on X-ray, however, clinically they appear to be much worse. On X-ray, you can see “shadowing” of the gouty tophaceous deposits on the medial aspect of the joint, which gives the impression clinically that the actual osseous deviation is larger. Luckily minimal erosions were present.
This particular patient was in marked pain and shoe wear was becoming a major concern for her.
Bunion corrective surgery was an option and she was very keen to move to surgery. An important aspect of this case is the need to remove or debride as much of the tophi as possible from the capsule before the bony work is carried out. This required a larger incision, however, you can see in the bottom right image an example of some of the removed tophi.
Excellent results were achieved and I have liaised with her GP to ensure she commences regular prophylactic medication (allopurinol) to reduce the chance of repeated tophi build-up.
If you have any specific questions or would like to discuss similar cases, feel free to contact me.
Also read:
Gout or degenerative osteoarthrosis/hallux limitus?
Gout deposits (not bunions)
Remember functional anatomy and to x-ray
(This content is intended for healthcare professionals only)