Uric acid crystals in skin of heel?

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I had a patient attend today with what appears to be Uric Acid Crystals in the skin of his foot. Some of these are on the plantar surface of his heel and causing pain due to callous formation etc.
I would be very grateful for some advice on treatment as I have never come across this before. If I remove them by whatever means will they return in the same place?
He tells me that he had similar on his hands and medication cleared them but has failed to do so on his foot. He didnt know the medication.

Thanks for any help.

Lorcan

 

Do you have a photo? I've only ever seen these around the toe joints.

 

Lorcan,
What makes you think these are uric acid crystals? Are you sure these aren't H Mille? Uric acid crystals form typically in joints not in the skin itself.

A photo would certainly help.

regards

Catfoot

 

Patient was diagnosed by Rheumatologist as having Psuedo-Gout and having crystals in his hands which he tells me had same appearance as foot lesions. They are not HM and I,m 99% certain that they are crystals.

When he presented they were very macerated due to his using salicylic acid. However he tells me that when he reduced the callous he was able to remove long glass like cylinders which were in the transverse plane on the foot.

 

Hi Lorcan & :welcome: to Podiatry Arena,

Gouty tophi formation in unusual areas I would personally refer back to the patients GP for further investigation.
Google Scholar ref:

Plus, if the patient is unaware of their medication either ask them to telephone you with the required information or contact their GP.

I'm with Catfoot in that photographs (with patient permission) would be great.

Either way I wouldn't guess.

Kind regards,

Mandy.

 

Lorcan,

I have come across this in a patient before. He was covered in superficial uric acid crystals. There is nothing ( as far as I'm aware) that can be done, they just continue to re-appear. My patient was under both rheumatology and dermatology for his. I think they have written a paper on him?

However before jumping to conclusions I would rule out Piezogenic Pedal Papules.

Cheers

 

Hi George,

Any chance you have a copy of the paper?

Many thanks,

Mandy.

 

Mandy,

i'll have a hunt around for it and get back to you.


George

 

Hi George
Thanks for your help. When you say that the crystals continue to reappear, do they nessecarily do so in the same location?

 

I have had 2 patients one in Bermuda & 1 in Edinburgh, in my career with the crystals or "Gouty Tophi" working their way out of the patients skin. They both presented with crystals in the heels. I basically enucleated the crystals out, applied a dressing and this kept the patients comfortable. It is sort of like a foreign body working its way to the surface - bit weird really.

 

HI Lorcan, Yes saw the same eruption on a diabetic patient 5-6 yeqrs ago. The crystals would form under the skin and then ulcerate. Once the crystals had been cleared from the small ulcrated areas, they would heal quite rapidly. Surprsingly the patient was a long-term diabetic, who did not manage his BSLs at all well, did not take his Gout meds, and yet all the painful lesions healed without further long term ulceration or scarring.
Laurie Foley
CHief Podiatrist
Fremantle Hospital
Fremantle Wstern Australia