Symptomatic os vesalianum pedis triggered by gouty tophus: A case report

Os Vesalianum Pedis (OVP) is an accessory bone at the base of the fifth metatarsal. While rare, symptomatic cases requiring surgery may arise following sports injuries or trauma. We present a unique case of symptomatic OVP induced by gouty tophi. A 25-year-old male with recurrent gout attacks had discontinued medication without supervision. One month before presentation, he experienced worsening foot pain that persisted despite resuming medication, prompting a visit to our department. Physical examination revealed swelling and tenderness in both lateral feet. Blood tests showed elevated uric acid and C-reactive protein. Imaging studies demonstrated osteolysis, marginal sclerosis, and erosion at the fifth metatarsal base. Surgical resection of the OVP relieved the pain completely. This is the first reported case of OVP induced by gouty tophi. Prolonged hyperuricemia likely promoted tophus formation, impairing mobility between the fifth metatarsal and OVP, resulting in pain.