Chronic gout leads to deposition of urates into a chalky mass known as a "tophus". Such tophi can destroy the joint and adjacent bone. The great toe is a common location for involvement. Seen here radiographically in sequential radiographs of the same foot (the patient did not have two right feet) is a tophaceous deposit that has destroyed the 1st MP joint and adjacent bone. In most, but not all, cases the patient has hyperuricemia.