Silent gout: an unusual presentation in diabetic neuropathy

Foot pathology presents a diagnostic challenge in diabetic patients with co-existent peripheral neuropathy. Pain is a key feature that assists in accurate diagnosis of disease and monitoring response to treatment.

We present a 71-year-old gentleman with peripheral neuropathy who reported mild midfoot pain that was associated with bony erosions throughout the midfoot. He had recently undergone amputation of the 5th toe that proved to be associated with staphylococcal infection and a presumptive diagnosis of osteomyelitis was made. Subsequent deep tissue sampling confirmed a diagnosis of severe tophaceous gout that had been masked by his peripheral neuropathy.

This case represents an unusual presentation of gout affecting the midfoot in a diabetic with peripheral neuropathy. It serves as a reminder of the importance of tissue sampling in these cases to confirm diagnosis before a definitive treatment plan is made.