A Case of a Second Intermetatarsal Space Gouty Tophus with a Presentation Similar to a Morton's Neuroma

Unusual Case of Gouty Arthritis of the Second Distal Interphalangeal Joint (Second Toe)

Gout is one of the most common diseases affecting men globally due to the spread of unhealthy dietary habits, kidney disease, and the use of diuretics. It is characterized as having monosodium crystals depositions in the synovial fluid, which causes an inflammatory response and painful joints. Most of the time, it can be found affecting the first metatarsophalangeal joint or other large joints in concurrence with other disorders. Non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, and steroids have been known to suppress such events in most cases without the need for any surgical intervention. We present a case of a 44-years-old medically free healthy male who presented with a case of gouty arthritis in the second distal interphalangeal joint. Initially, colchicine treatment was given along with NSAIDs, but symptoms failed to subside. After a persistent increase of swelling and pain, the surgical evacuation was sought to reduce the pain and exclude any other causes of arthritis. Histopathology report confirmed the presence of monosodium urate crystals without any signs of infection. In conclusion, surgical intervention of gouty arthritis can be beneficial in cases of persistent pain and increasing rate of swelling despite the medicinal trial, especially in unusual cases of gouty arthritis such as gout of the second metatarsophalangeal joint.