Gouty tophus as a rare cause of a Hepple stage V osteochondral lesion of the talus

Abstract

Background Talus osteochondral lesion is commonly associated with trauma, avascular necrosis or even genetic factors, but gouty tophus as a cause of Hepple stage V type talus osteochondral lesion is rare. Case presentation Here, we report a case of an 18-year-old man who complained of left medial deep ankle pain on ambulation. This young man had an extreme liking of sea food rich in purines and also sugar-sweetened drinks. He was diagnosed with a Hepple stage V type talus osteochondral lesion and was treated with medial malleolus osteotomy and an osteochondral graft. The talus osteochondral lesion was found to be a gouty tophus and was completely removed. Hypouricemic therapy was prescribed for 2 months, which allowed the patient to walk with a visual analogue score (VAS) score of 1. He was followed up for 12 months. Conclusions Young people with an extreme liking of sea food rich in purines and also sugar-sweetened drinks may be at a risk of developing gout. Acute onset of ankle atraumatic pain, swelling with a high level of serum uric acid and a talus osteochondral lesion with cyst formation should make physicians consider a diagnosis of gout.

Arthroscopic surgery for ankle gouty arthritis: a retrospective analysis of clinical outcomes at six month follow-up based on a novel classification system

“…Osteochondral lesions of the talus (OLT) are typically ascribed to either traumatic or haematologic origins, whereas gout-induced OLT is extremely rare [ 24 ]. Both Taeho and Tao have each reported a case of a male adolescent presenting with an OLT bone cyst accompanied by MSU crystal deposition [ 25 , 26 ]. Interestingly, neither patient had a history of trauma to the foot or ankle, and both bone cysts were situated medially to the talus.…”