ULCERATED GOUTY TOPHI

P.G. is a Diabetic with loss of feeling in his feet. Technically, we call this "LOPS" (Loss of Protective Sensation). He has multiple areas of gout crystals under the skin on his feet, ankles, legs, hands, and elbows. This particular area is at the outside of his left ankle, and has ulcerated through the skin. The crystals can be seen in the base of the ulcer, and are chalky and rock hard. They also show up on X-ray.