The radiographic image shows right first distal metatarsal fracture (curved arrow) and a lytic lesion. It is important to observe the “Martel’s sign”, which is a radiological sign (straight arrow) to describe the overhanging margin of the new bone along the edge of erosion, named after W. Martel who first described this sign in 1968. Martel’s sign is not present in all cases of gouty arthritis.
Gouty tophi are masses resulting from soft tissue deposition of urate crystals. The erosions of gouty arthritis are outlined with sclerotic margins. As the tophus erodes the bone, it produces an overhanging C-shaped edge of bone characteristic of gouty arthritis. This gives the characteristic “Martel sign”. Intraosseus crystal deposition occurs in rare cases. Fracture secondary to gout is rare. The mainstay of treatment for tophaceous gout is pharmacologic control of hyperuricemia. Treatment can lead to shrinkage or resolution of tophi.