Ulcerated tophaceous gout of the foot: a case report and retrospective chart review.

Abstract

Ulcerated tophaceous gout is an uncommon presentation of the lower limbs. Treatment of these wounds can be a challenge, as their optimal management remains to be determined. Therefore, a retrospective analysis of medical charts between 2015 and 2021 was conducted at a wound clinic of a university-affiliated hospital to determine the characteristics of patients treated for tophaceous wounds, their evolution and treatment. We report a total of five patients with ulcerated tophaceous gout of the foot who initially presented predominantly with soft tissue infection or osteomyelitis. All progressed well with local wound care, including conservative sharp debridement of the tophi and rapid initiation of urate-lowering therapy. Therefore, a diagnosis of tophi should be considered in an ulceration of the first metatarsophalangeal joint or other toes when whitish-chalky material is present, even if the patient was not previously known to have gout. Tophi ulceration is a rare complication; however, prompt diagnosis and management are important to avoid destruction of the underlying bone structures.