If treatment for a gouty toe requires surgical removal of tophi, something has gone seriously wrong.

Unfortunately, grotesque photographs and videos of tophi being removed from the big toe are far too common. I will subject you to more gruesome pictures soon, just to emphasize the point. You should prevent gout getting to this stage, and avoid treatment for gout that involves surgery.

Do not assume you automatically get the treatment you need to avoid surgery. In the gout case report where I found the photographs, there is an indication that uric acid levels were not being managed properly[1]. The patient had a history of gout, was being prescribed allopurinol, yet uric acid was 6.4 mg/dL. The advice from rheumatologists for safe uric acid levels is 5 mg/dL or lower. 6.4 is not outrageously high, but in the colder regions of the big toe, it is far from safe.

There is a further complication in this gout case study, as it features Viagra (sildenafil). The link between gout and Viagra is discussed occasionally and mentioned on pack inserts, yet the evidence for a link is very unreliable. People often try to link unrelated health issues, and when that is reported in clinical trials, it has to be included in product information. However, there is nothing to suggest in any reports that this is anything other than coincidence, coupled with a very poor understanding of gout.

Anyway, that is not the issue here, so let me return to consider this dramatic treatment for a gouty toe.

Gouty Toe Surgery for Victim Case Study

This gout case concerns a 58-year-old male with a history of gout, high blood pressure, and heart disease. He was admitted to hospital after two months of pain, and difficulty wearing his shoe. Mobility was limited due to pain and swelling in the big toe. As you can see by the “Before” photograph below. Showing tophi in big toe prior to removal by surgery.

Appropriate treatment for gout in the toe was determined to be surgery. Blood supply to the toe was restricted, and the tophi removed. Examination of the chalky white material revealed uric acid crystal deposits.

Toe Tophi Surgery on Gout Victim
Treatment for gout in this victim’s toe is surgical removal of tophi

The authors of the case study note:

Tophaceous gout may lead to significant morbidity and, if untreated, can cause joint erosion and destruction. The tophaceous material may present in a liquid, pasty, or chalky/granular state. Treatment may be as simple as aspirating the liquid or squeezing out pasty tophaceous material. Surgery is often indicated for the patient with significant tendon and joint compromise as well as skin breakdown.

Read more about tophi removal in the treatment for gout guidelines.

Leave Gouty Toe Surgery for Victims to browse the Treatment for Gout guidelines. Or return to Step 6 of your GoutPal Plan for Gout Victims

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Gouty Toe Surgery for Victims References

  1. Alici, Tugrul, Yunus Imren, Mehmet Erdil, and Hakan Gundes. “Gouty arthritis at interphalangeal joint of foot after sildenafil use: A case report.” International journal of surgery case reports 4, no. 1 (2013): 11-14.

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