Tophaceous gout deposits in the first MTP joint cause destruction leading to hallux rigidus. The definitive indicator for surgical intervention (first MTP fusion) in chronic tophaceous gout versus conservative management is:

• A Serum uric acid level >8 mg/dL despite allopurinol therapy
• B Visible tophi on clinical examination regardless of functional status
• C Dual-energy CT confirming monosodium urate crystal deposition
• D Painful limitation of MTP motion refractory to medical management causing functional disability, with or without joint destruction on X-ray ✓

Explanation

Surgical intervention for hallux rigidus/tophaceous MTP involvement is indicated when joint destruction and pain cause significant functional disability that is refractory to medical optimisation (urate-lowering therapy, anti-inflammatory drugs). Arthrodesis (MTP fusion) is the gold standard for end-stage joint destruction, providing reliable pain relief and stability. Elevated uric acid alone without functional failure or the mere presence of tophi (without pain/disability) does not mandate surgery. DECT confirms the diagnosis but does not indicate surgery.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.