Year 2019 / Volume 30 / Number 1

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Clinical Cases

Extraction of gotous tofos. Clinical case.

Rev. Esp. Pod. 2019; 30(1): 24-30 / DOI: 10.20986/revesppod.2019.1515/2018

José María del Pino Torres, Fernando Martínez Merino


ABSTRACT

This article shows a clinical case of an 83-year-old patient with persistent pain at the level of the 1st metatarsophalangeal and interphalangeal joint of the left foot, as well as a large deformity that prevented her from fitting properly. After the first exploration, diagnosis of presumption was directed towards gout. Gout is a disease caused by an accumulation of crystals of monosodium urate in different parts of the body, especially in the joints, soft tissues and kidneys. Although the radiological reports did not comfirm gout, clinical findings indicated that the previous diagnosis of gout was the most probable and a Du Vries cheilectomy was performed to improve Hallux Limitus symptoms and mechanical removal of the first toe gout deposits with an skin plasty to remove excess of skin plasty. Special care was taken to respect plantar structures not compromising the plantar skin in the future and avoid postoperative fibrosis. Pain relief was achieved with a mobility of the first metatarsophalangeal joint within normal limits, with a slightly insufficient first radius, but no postoperative treatment with plantar supports was necessary. After more than a year, the results are optimal, being able to make a completely normal life and with a fully recovered functionality.



RESUMEN

El presente artículo muestra un caso clínico de una paciente de 83 años que presentaba dolor persistente a nivel de la 1ª articulación metatarsofalángica e interfalángicas del pie izquierdo, así como una gran deformidad que le impedía calzarse de forma adecuada. Tras la primera exploración, el diagnóstico de presunción se encaminó hacia la gota. La gota es una enfermedad producida por una acumulación de cristales de urato monosódico en distintas partes del cuerpo como articulaciones, tejidos blandos y riñones. A pesar de que los informes radiológicos apuntaban a otro tipo de lesiones, la clínica indicaba el diagnóstico clínico estaba más acorde con el problema y se decidió realizar intervención quirúrgica mediante queilectomía de Du Vries para mejorar la sintomatología y eliminar los tofos gotosos del primer dedo y plastia de piel sobrante, con especial cuidado de respetar en la medida de lo posible las estructuras plantares para no comprometer la piel plantar y evitar posible fibrosis posterior. Se consiguió alivio del dolor con una movilidad de la primera articulación metatarsofalángica dentro de límites normales, con un primer radio ligeramente insuficiente, pero no siendo necesario un tratamiento postquirúrgico con soportes plantares para mejorar la funcionalidad. Tras más de un año, los resultados obtenidos fueron óptimos, pudiendo hacer una vida completamente normal y con una funcionalidad completamente recuperada.


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del Pino Torres J, Martínez Merino F. Extraction of gotous tofos. Clinical case.. Rev Esp Pod 2019; 30(1): 24-30 / DOI: 1020986/revesppod20191515/2018


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Ficha Técnica

Recibido: 19/03/2018

Aceptado: 05/03/2019

Prepublicado: 17/04/2019

Publicado: 28/06/2019

Tiempo de revisión del artículo: 349 días

Tiempo de prepublicación: 394 días

Tiempo de edición del artículo: 466 días


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2024 Revista Española de Podología
ISSN: 0210-1238   e-ISSN: 2695-463X

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