Case contributed by Ian Bickle
Diagnosis almost certain


Swollen deformed great toe.

Patient Data

Age: 70 years
Gender: Male

Lucency, bony erosion and destruction of the proximal and distal phalanges of the great toe centered on the interphalangeal joint. Associated soft tissue swelling.

No calcification in the soft tissues.

Erosion on the dorsal aspect of the medial cuneiform.


The Gout (James Gillray, 1799) depicts the pain of the artist's podagra as a demon or dragon

James Gillray (1756-1815) was a British caricaturist and printmaker famous for his distinct style of political and social satire cartoons and hence his iconic status as the father of the political cartoon.

The original image can be found at: https://commons.wikimedia.org/wiki/File:The_gout_james_gillray.jpg. (This image is free of copyright and can be used without any license requirements).

Case Discussion

This is an extreme example of very advanced gout.  The big toe is a classic site and historically well documented with the term podagra.

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