Giant Tophi in the Calf

Kao, Jsun‐Liang; Hung, Jyi-Jyh; Huang, Ching-Hua; Shiao, Chih‐Chung

doi:10.2169/internalmedicine.51.6825

Cited by 4 publications

(5 citation statements)

References 2 publications

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“…While it is possible that intra-muscular tophus deposition would reduce the working area of the muscle and its ability to produce adequate force [ 28 ], it seems unlikely that this is a dominant mechanism. Numerous studies have reported tophus deposition within joints, tendons and ligaments involved in foot and ankle function [ 12 , 14 , 29 ], but muscle deposition appears to be rare, with evidence limited to a few case reports [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Clinically‐evident tophi are associated with reduced muscle force in the foot and ankle in people with gout: a cross‐sectional study

Stewart

Dalbeth

Otter

et al. 2017

Journal of Foot and Ankle Research

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BackgroundThe foot and ankle represent a common site for tophi in people with gout, yet it is unclear whether the presence of tophi is related to impaired muscle function. This study aimed to determine the association between foot and ankle tophi and muscle force in people with gout.MethodsParticipants with gout were stratified into two groups based on the presence of clinically-evident tophi affecting the foot or ankle on physical examination. Isometric muscle force for plantarflexion, dorsiflexion, inversion and eversion was measured using static dynamometry. Mixed-models regression was used to determine the difference in muscle force between the two groups while adjusting for age, disease duration and foot pain. This model was also used to determine the difference in muscle force between presence and absence of tophi at specific locations within the foot and ankle. In addition, Pearson’s correlations were used to determine the association between total foot tophus count and muscle force.ResultsFifty-seven participants were included (22 with foot or ankle tophi and 35 without foot or ankle tophi). Foot and ankle tophi were most often seen at the Achilles tendon. After adjusting for age, disease duration and foot pain, participants with tophi had significantly reduced muscle force during plantarflexion (P < 0.001), dorsiflexion (P = 0.003), inversion (P = 0.003) and eversion (P = 0.001) when compared to participants without tophi. Those with Achilles tophi had significantly reduced force during plantarflexion (P < 0.001), inversion (P = 0.008) and eversion (P = 0.001). No significant differences in muscle force were observed between the presence and absence of tophi at other foot or ankle locations. There were also no significant correlations between total foot tophus count and muscle force (all P > 0.05).ConclusionIn people with gout, clinically-evident foot or ankle tophi are associated with muscle force deficits during foot plantarflexion, dorsiflexion, inversion and eversion, which persist despite adjusting for age, disease duration and foot pain. Tophi at the Achilles tendon, which associate with force deficits, may contribute to reduced muscular activation and consequent disuse muscle atrophy.

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Section: Discussionmentioning

confidence: 99%

Clinically‐evident tophi are associated with reduced muscle force in the foot and ankle in people with gout: a cross‐sectional study

Stewart

Dalbeth

Otter

et al. 2017

Journal of Foot and Ankle Research

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“…Furthermore, the infiltration of tophi into muscle tissues may potentially reduce the functional cross-sectional muscle area (i.e. area of active working muscle) and thereby the potential to generate force [25].…”

Section: Discussionmentioning

confidence: 99%

Foot and ankle muscle strength in people with gout: A two-arm cross-sectional study

Stewart

Mawston

Davidtz

et al. 2016

Clinical Biomechanics

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Foot and ankle muscle strength in people with gout: a two-arm cross-sectional study, Clinical Biomechanics (2015Biomechanics ( ), doi: 10.1016Biomechanics ( /j.clinbiomech.2015 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT ABSTRACTBackground Foot and ankle structures are the most commonly affected in people with gout.However, the effect of gout on foot and ankle muscle strength is not well understood. The primary aim of this study was to determine whether differences exist in foot and ankle muscle strength for ankle plantarflexion, dorsiflexion, inversion and eversion between people with gout and age-and sex-matched controls. The secondary aim was to determine whether foot and ankle muscle strength was correlated with foot pain and disability.Methods Peak isokinetic concentric muscle torque was measured for ankle plantarflexion, dorsiflexion, eversion and inversion in 20 participants with gout and 20 matched controls at two testing velocities (30°/s and 120°/s) using a Biodex dynamometer. Foot pain and disability was measured using the Manchester Foot Pain and Disability Index (MFPDI).Findings Participants with gout demonstrated reduced muscle strength at both the 30°/s and 120°/s testing velocities for plantarflexion, inversion and eversion (p<0.05). People with gout also displayed a reduced plantarflexion-to-dorsiflexion strength ratio at both 30 o /s and 120 o /s (p<0.05). Foot pain and disability was higher in people with gout (p<0.0001) and MFPDI scores were inversely correlated with plantarflexion and inversion muscle strength at the 30°/s testing velocity, and plantarflexion, inversion and eversion muscle strength at the 120°/s testing velocity (all p<0.05).Interpretation People with gout have reduced foot and ankle muscle strength and experience greater foot pain and disability compared to controls. Foot and ankle strength reductions are strongly associated with increased foot pain and disability in people with gout.

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“…Relevant literature of giant tophi always showed rare positions such as hands, calf, bone marrow, and others. [ 8 – 10 ] Falidas [ 11 ] reported a case with a large tophaceous gouty tophi at MTP1 which underwent a surgical debridement. The patient got the joint saved because the arthritis of MTP1 was not serious enough.…”

Section: Discussionmentioning

confidence: 99%

“…[ 12 ] Approximately, 79% of MTP1 in patients with long-term gout tophi had bone erosions evidenced by radiography. [ 10 ]…”

Section: Discussionmentioning

confidence: 99%

Amputation of the first metatarsophalangeal joint due to a giant gouty tophi

et al. 2017

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Rationale:The first metatarsophalangeal joint (MTP1) is the most frequent site of gouty tophi. We report an unusual case with a giant skin-perforating tophi. This is the first case of gouty tophi at MTP1 which accepts surgical debulking and amputation.Patient Concerns:A 42-year-old man presented with a seven-year history of gout and a giant tophi at MTP1. The patient was referred to hospital due to persistent pain and ulcerations on the surface of the left MTP1. This rounded, giant, swelling, tophaceous tophi severely interfered with his normal walking.Diagnoses:The patient was diagnosed with gouty arthritis seven years ago, and did not receive regular anti-gout treatments.Outcomes:Biochemical examination showed he had raised serum uric acid (SUA, 11.92 mg/dl) and creatinine (258 μmol/l). There was a severe joint destruction of MTP1 by X-ray examination. We controlled the skin infection by sulbenicillin. He was given febuxostat to reduce SUA. After 3 months of treatment, SUA fell to 6.8 mg/dl. Then we performed surgical debulking of MTP1 and amputation of hallux. Surgical operations obviously relieved the pain, and improved the function of his left foot. The visual closure after amputation was good.Conclusion:Surgical amputation of the gout lesion at MTP1 maximized the function, and reduced the pain of this patient. In the case of giant tophi with severe gouty arthritis or skin infections, surgical decisions need to weigh gains and losses carefully.

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Giant Tophi in the Calf

Cited by 4 publications

References 2 publications

Clinically‐evident tophi are associated with reduced muscle force in the foot and ankle in people with gout: a cross‐sectional study

Clinically‐evident tophi are associated with reduced muscle force in the foot and ankle in people with gout: a cross‐sectional study

Foot and ankle muscle strength in people with gout: A two-arm cross-sectional study

Amputation of the first metatarsophalangeal joint due to a giant gouty tophi

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