The right foot x-ray shows a punched out erosion over the medial aspect of the first metatarsal head with sclerotic margins and an overhanging edge (also called Martel’s hook).

There is also soft tissue swelling medially over the 1st MTP joint with small foci of calcification. This x-ray appearance is typical of gout.

Important x-ray features of chronic gouty arthritis are-

• Punched out erosions
• Overhanging margins
• Preserved joint space
• No peri articular osteopenia