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G OUT IS THE most common form of inflammatory arthritis and is quite common in the foot. Multiple acute "gouty" flares can result in chronic uric acid accumulation known as tophus (s.) or tophi (pl.). Two distinct chronic conditions of the foot/ ankle can arise from this accumulation. Both of these conditions are seen in the geriatric population and may require surgical intervention. Overwhelming soft-tissue tophus. As uric acid accumulates in a joint or other soft-tissue space, the tophi can extrude though the skin. The portal created by tophi extrusion typically has deep tissue extension and can lead to the development of a significant abscess. While portal-related cellulitis can often be treated with oral antibiotics, surgical management of cavitary infection may be necessary. Erosive degenerative joint disease. Intra-articular uric acid accumulation can also result in extensive synovitis. With time this can lead to erosive, destructive changes of the articular and peri-articular surfaces. These accelerated degenerative changes typically cause significant and even debilitat- ing joint pain in addition to loss of joint motion. Given that these findings can result in significant loss of foot function and quality of life, surgical management may be neces- sary. Less active patients may do well with a non-implant arthroplasty procedure which involves removal of affected joint surfaces. However, fusion of the tophaceous joint can provide a durable long-term outcome as it addresses both joint pain and future gouty flares. * Dr. Jeffrey Whitaker is board-certified in Foot and Ankle Surgery and a Fellow of the American College of Foot and Ankle Surgeons. He is Division Head and Associate Professor-Podiatric Surgery at Kent State University College of Podiatric Medicine in Independence, OH. ■ *Source: Kim YS, Park EH, Lee HJ, Koh YG. First metatarsophalangeal joint arthrodesis for the treat- ment of tophaceous gouty arthritis. Orthopedics. 2014 Feb;37(2):e141-7. When Is It a Surgical Problem? Gouty Arthropathy in the Foot: By Jeffrey M. Whitaker, DPM HEALTHCARE ADVOCATES, INDUSTRY LEADERS With more than 40 years of experience, our Healthcare Section offers Healthcare Representation & Counseling, Coding Review and Staff Training. We make it possible for you to focus on patient care, while we tackle the legal obstacles you are faced with on an ongoing basis. WE ARE THE HEALTHCARE SECTION OF KRUGLIAK, WILKINS, GRIFFITHS & DOUGHERTY, CO., L.P.A. 4775 Munson Street N.W. | P.O. Box 36963 | Canton, Ohio 44735 | 330-497-0700 | Fax 330-497-4020 John M. Tucker • Randall C. Hunt • Fred J. Haupt Jason F. Haupt • Laura A. Brady Offices in Canton, Akron, Alliance, New Philadelphia & Sugarcreek KWGD.com 2 0 1 4 J U LY/AU G U S T ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 2 5