A Red, Painful, and Swollen Foot Overlying a Bone Erosion

A 67-year-old man presented with 3 days of intense pain, redness, and swelling of the left fifth toe, which had been extremely troubling (Figure 1). There was no antecedent trauma, insect bite, or change in medication. He denied fever, chills or walking barefoot. He had known hypertension and vitamin D deficiency. As a child, he was diagnosed with psoriasis; skin lesions intermittently recurred into adulthood. Both his parents had gout and a grandfather had psoriasis.