Middle Facet Degeneration and Gout

Chronic gout, and years of wear-n-tear from hauling the mail, on foot, in this 60 yo male!

I have not seen a lot of tophaceous gout at the TN, but this fellar had a nice collection of cottage cheese at the dorsum of the joint intra-op.. Pain at dorsal TN, and with STJ range of motion. Particularly, middle facet degeneration. ….Just a nice simple Gastroc recession, TN tidy up, and ST arthrodesis.
He was back carrying mail in 12 weeks.