case_images: PMC11436267_01
case_images: Preoperative radiographs of the left ankle demonstrating anteroposterior (A), oblique (B), and lateral (C) views. Plantar and posterior enthesophytes of the calcaneus are indicated with the arrows.
case_images: CRIOR2024-8878405.001.jpg
case_images: PMC11436267_01_CRIOR2024-8878405.001.jpg
case_images: fig1
case_images: When he presented back to the orthopedic surgery clinic after 7 months of conservative management, his physical exam was significant for tenderness to palpation along the posterior aspect of the heel in addition to evidence of significant swelling and regrowth of bone spurs along the posterior aspect of the Achilles tendon as is demonstrated in Figure 1.
case_images: T2 fat suppression MRI with coronal (A), axial (B), and sagittal (C) views of the left ankle with arrows demonstrating thickening and the abnormal signal characteristic of Achilles tendinitis. Notably, there is no radiographic evidence of gouty tophi.
case_images: CRIOR2024-8878405.002.jpg
case_images: PMC11436267_01_CRIOR2024-8878405.002.jpg
case_images: fig2
case_images: Before the revision procedure, the MRI scan that was performed at his initial clinic visit 7 months prior to his current presentation was examined and can be seen in Figure 2.
case_images: Light microscopy of central acellular amorphous pale eosinophilic material (green arrow) surrounded by histiocytes and multinucleated giant cells (red arrow). The central acellular amorphous pale eosinophilic material represents the area previously occupied by the monosodium urate crystals, which become dissolved in the histological staining process, and the surrounding histiocytes and multinucleated giant cells make up the foreign body granulomatous reaction that surrounds the previous location of the monosodium urate crystals, which are characteristic of gout. H&E stain. Magnification x40.
case_images: CRIOR2024-8878405.003.jpg
case_images: PMC11436267_01_CRIOR2024-8878405.003.jpg
case_images: fig3
case_images: The pathology report came back with findings that are demonstrated in Figure 3 and are consistent with gouty tophi.