J Korean Foot Ankle Soc.  2016 Jun;20(2):84-87. 10.14193/jkfas.2016.20.2.84.

Tarsal Tunnel Syndrome Associated with Gout Tophi: A Case Report

• Park SG
• Park CH
• Ahn HS

• KMID: 2219408
• DOI: http://doi.org/10.14193/jkfas.2016.20.2.84

Abstract

Tarsal tunnel syndrome is an entrapment neuropathy of the posterior tibial nerve or its branches in the fibro-osseous tunnel beneath the flexor retinaculum. This pathology is associated with multiple etiologies, including trauma, space-occupying lesions, and impaired biomechanics. We report a case of tarsal tunnel syndrome associated with gout tophi in a patient with untreated gout along with a review of the relevant literature on tarsal tunnel syndrome.

Keyword

Tarsal tunnel syndrome; Gout; Tophi

MeSH Terms

Gout*
Humans
Pathology
Tarsal Tunnel Syndrome*
Tibial Nerve

Figure

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  Figure 1. Axial computed tomograph shows osteolytic changes with subcortical cysts and multiple calcifications in the talar body (A) and in the first and second tarsometatarsal joints (B).

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  Figure 2. Coronal magnetic resonance images show an ill-defined mass in the talar body with low signal intensity on T1-weighted imaging (A) and of heterogeneous signal intensity on T2-weighted imaging (B).

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  Figure 3. (A, B) Intraoperative photo shows a gouty tophus compressing the medial plantar nerve. (C) The excised mass was composed of a yellowish tissue.

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  Figure 4. Histopathologic findings with H&E stain (A: ×100, B: ×200) show the presence of crystal deposits surrounded by a scalloping of palisaded histiocytes and multinucleated giant cells (arrows) containing an amorphous-appearing pale to pink deposits in the center (arrowheads).

Reference

1.Ahmad M., Tsang K., Mackenney PJ., Adedapo AO. Tarsal tunnel syndrome: a literature review. Foot Ankle Surg. 2012. 18:149–52.

2.Lau JT., Daniels TR. Tarsal tunnel syndrome: a review of the lit-erature. Foot Ankle Int. 1999. 20:201–9.

3.Sung KS., Park SJ. Short-term operative outcome of tarsal tunnel syndrome due to benign space-occupying lesions. Foot Ankle Int. 2009. 30:741–5.

4.Lui TH. Acute posterior tarsal tunnel syndrome caused by gouty tophus. Foot Ankle Spec. 2015. 8:320–3.

5.Wakabayashi T., Irie K., Yamanaka H., Iwatani M., Inoue K. Tarsal tunnel syndrome caused by tophaceous gout a case report. J Clin Rheumatol. 1998. 4:151–5.

6.Janssens HJ., Janssen M., van de Lisdonk EH., van Riel PL., van Weel C. Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial. Lancet. 2008. 371:1854–60.

7.Falidas E., Rallis E., Bournia VK., Mathioulakis S., Pavlakis E., Villias C. Multiarticular chronic tophaceous gout with severe and multiple ulcerations: a case report. J Med Case Rep. 2011. 5:397.

8.Chen CK., Yeh LR., Pan HB., Yang CF., Lu YC., Wang JS, et al. Intra-articular gouty tophi of the knee: CT and MR imaging in 12 patients. Skeletal Radiol. 1999. 28:75–80.

9.Fitzgerald BT., Setty A., Mudgal CS. Gout affecting the hand and wrist. J Am Acad Orthop Surg. 2007. 15:625–35.

10.Takakura Y., Kitada C., Sugimoto K., Tanaka Y., Tamai S. Tarsal tunnel syndrome. Causes and results of operative treatment. J Bone Joint Surg Br. 1991. 73:125–8.