A 58-year-old man with tophaceous gout has chronic pain, recurrent ulceration, and difficulty wearing footwear due to large bilateral calcaneal tophi. Serum urate is 11 mg/dL on maximum medical therapy. The most appropriate surgical management is:
- A Below-knee amputation
- B Tophi excision with primary closure ✓
- C Arthroscopic debridement of the subtalar joint
- D Calcaneal osteotomy
Correct answer: B. Tophi excision with primary closure
Explanation
Surgical excision of tophi is indicated when they cause skin breakdown, infection, nerve compression, or functional impairment despite optimal urate-lowering therapy. Tophi excision with primary closure is the standard approach for accessible subcutaneous tophi. Amputation is reserved for intractable infection or malignancy. Arthroscopic debridement does not address the tophaceous mass. Calcaneal osteotomy is unrelated.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.