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Gouty arthritis, multiple toes

Case submitted by Stephen Albert, DPM, FACFAOM

62 y/o Vietnam era veteran complains of pain in multiple locations of both feet, associated with weight-bearing activities. Medical history: gout, chronic kidney disease, prostate cancer, hypertension, allergic rhinitis and peripheral vascular disease. No known allergies.
There are well-defined erosions involving the hallux interphalangeal and 1st metatarsophalangeal joints. Significant portions of the 3rd and 4th toe middle and proximal phalanges are absent. The remaining margins are well-defined in outline. Multiple geographic increased densities are seen at the involved joints.
Other findings include tubular, serpiginous calcifications between the 1st and 2nd metatarsals.
Diagnoses: Chronic tophaceous gout. Mönckeberg’s sclerosis.