I think this is the best tophi picture. Because it shows successful tophi treatment. Most tophi photographs are horrible. But I think you should know the dangers of untreated gout.
Despite the advances in science that mean we can now control gout, there is a tiny minority who cannot tolerate common uric acid-lowering treatment. If you do not get uric acid to safe concentration, you are doomed to the continuous growth of tophi. So, you might treat the pain, but can you control the gout?
Pain relief without uric acid control means more and more uric acid crystals that will eventually show themselves as gouty tophi.
If treatment for gout in toe requires surgical removal of tophi, something has gone seriously wrong.
Unfortunately, grotesque photographs and videos of tophi being removed from the big toe are far too common. I will subject you to more gruesome pictures soon, just to emphasize the point. You should prevent gout getting to this stage, and avoid treatment for gout that involves surgery.
Do not assume you automatically get the treatment you need to avoid surgery. In the gout case report where I found the photographs, there is an indication that uric acid levels were not being managed properly. The patient had a history of gout, was being prescribed allopurinol, yet uric acid was 6.4mg/dL. The advice from rheumatologists for safe uric acid levels is 5mg/dL or lower. 6.4 is not outrageously high, but in the colder regions of the big toe, it is far from safe.
There is a further complication in this gout case study, as it features Viagra (sildenafil). The link between gout and Viagra is discussed occasionally and mentioned on pack inserts, yet the evidence for a link is very unreliable. People often try to link unrelated health issues, and when that is reported in clinical trials, it has to be included in product information. However, there is nothing to suggest in any reports that this is anything other than coincidence, coupled with a very poor understanding of gout.
Anyway, that is not the issue here, so let me return to consider this dramatic treatment for gout in toe.
Treatment for gout to remove tophi and other uric acid crystal deposits.
When uric acid crystals form in the body, they usually lead to gout. Though gout treatment varies in quality, the most proficient doctors realize that uric acid needs to be controlled to stop gout returning. Elsewhere in this treatment section, I look at standard uric acid lowering methods and the pain control that is required until these methods become effective. That is the best way to stop gout – control uric acid before it can cause too much damage.
Unfortunately, many gout sufferers do not get the treatment they need early enough. Left untreated, uric acid crystals form deposits in the body called tophi. These are dangerous, and so you must prevent them or remove them. Ignoring them is not an option. My tophi pages explain the death and destruction that awaits anyone who ignores tophi. Here, I explain treatment for gout to remove uric acid crystal deposits, including tophi.
Though tophi are usually seen as lumps beneath the skin, uric acid deposits can form throughout the body. They are particularly painful if they form in the kidney, bladder or urinary tract. Sometimes uric acid crystals are called stones (e.g. kidney stones). Other times they are called tophi.
Whatever you call uric acid crystal deposits, they cannot be ignored. As gout continues untreated, the deposits grow larger and harder. They can damage joints and soft tissues as they grow. In these cases, or where joint mobility is impaired, or skin tissue is at risk of infection, then immediate treatment for gout is required.
Treatment For Gout To Remove Tophi
Where there is no time to wait for uric acid lowering drugs to take full effect, we must use other, often more drastic, treatments for gout to remove urate deposits.
These treatments (often used in combination) include:
lithotripsy (shockwaves/laser to shatter stones)
Surgery to remove tophi is the most common form of treatment for gout. You can see more details in the tophi guidelines, and in treatment for gout information. If treatment is sought before tophi become too hard, surgery might be limited to a lancing procedure. Some family doctors and podiatrists provide this procedure.
Now that you have seen ways to remove uric acid deposits, you need to remember that, until most crystals have dissolved, you are at risk of acute gout flares. You can manage this by taking pain relief as required, or daily for a few months as a preventative (prophylactic) measure.
I describe medical and alternative forms of gout pain relief in other parts of this Gout Treatments Section.
This is my layman’s summary of a report from the University Hospital, Granada, Spain:
Gouty Tophi in the Penis: A Case Report and Review of the Literature
José Francisco Flores Martín, Fernando Vázquez Alonso, Ignacio Puche Sanz, Raquel Berrio Campos, Miguel Angel Campaña Gutierrez, and José Manuel Cózar Olmo
Case Reports in Urology, vol. 2012, Article ID 594905, 3 pages, 2012. doi:10.1155/2012/594905
The author’s summary is:
Gout is a metabolic disease characterized by hyperuricemia and the deposition of monosodium urate crystals in different anatomical locations. We report the case of a 61-year-old man who received consultation for gouty tophi in the penis, which is an unusual location for this type of pathology, that was resolved with the surgical removal of the tophi. We provide a review on gout and its treatment as well as other locations where atypical gouty tophi have been described.
Penis Tophi Report: Introduction
Gout symptoms usually involve recurrent bouts of swollen joints and high uric acid in the blood leading to crystals forming in and around the joints. Gout patients often have lumps or tumors under the skin called gouty tophi.
The most common sites of tophi include the ears, elbow, knee, and the heal as well as under the skin of the hands, feet, and elbows. Tophi vary in quantity, size, and shape. They are yellowish-white in color with firm, smooth or ulcerated appearance and are, in most cases, highlighted on the skin [1, 2].
This report records the case of a patient with penis tophi, which the authors note is “an exceptional location for this condition.”
Penis Tophi Report: Case Presentation
A 61-year-old male had a history of high blood pressure and years of high uric acid and gout. He consulted for 4 small lumps on his inflamed penis that caused him pain during erection. The largest lump was 2.5 cm, suggestive of gouty tophi.
The patient also had similar lumps of various sizes on his hands, feet, and elbows, which were painless. He was treated with allopurinol and NSAIDs, but despite treatment, the lumps did not disappear. His uric acid blood test results were 9 mg/dL.
The tophi was removed surgically, and analyzed to confirm that it did contain uric acid crystals. The patient was without symptoms for 9 months after surgery.
Penis Tophi Report: Discussion
The report has 2 paragraphs describing the nature and incidence of gout [3, 5].
There are 4 forms of gout:
High uric acid with no other symptoms (asymptomatic hyperuricemia)
Regular gout with swollen painful joints (gouty arthritis)
Gout in remission with no painful attacks (intercritical gout)
Gout with visible lumps (chronic tophaceous gout)
This case is concerned with the last type, and the report describes the lumps. They are a mass of uric acid crystals surrounded by white blood cells. These white blood cells include the expected immune system cells, but also immature specialist cells. These specialist cells in healthy individuals are destined to repair and renew body tissues. 
Gout occurs after many years of high uric acid. Usually it starts with painful swollen joints. After about 5 more years, high uric acid leads to tophaceous gout.  Though usually around the ears and joints, tophi have been reported in other unusual locations. These include:
The report describes how tophi may be resolved by lifestyle improvements, but usually by uric acid lowering drugs. There may be reasons why surgery is necessary to avoid discomfort or immobility. [6, 8, 9] In this case allopurinol was not sufficient to reduce the tophi, so surgery was the answer. See other alternatives to surgery to remove tophi in the treatment for gout guidelines.
Penis Tophi: Next Steps
We can see that it is not sufficient to treat gout pain alone. We must control uric acid to prevent gout moving to the tophaceous stage. Once it has reached that stage, surgery is often required.
R. C. Landis and D. O. Haskard, “Pathogenesis of crystal-induced inflammation,” Current Rheumatology Reports, vol. 3, no. 1, pp. 36–41, 2001.
K. N. Kelley, “Approach to the patient with hyperuricemia,” in Textbook of Rheumatology, W. N. Kelley, E. D. Harris, S. Ruddy, et al., Eds., pp. 1340–1347, W.B. Saunders, Philadelphia, Pa, USA, 2nd edition, 1985.
M. A. Becker, “Hyperuricemia and gout,” in The Metabolic and Molecular Bases of Inherited Disease, C. R. Scriver, A. L. Beaudet, W. S. Sly, et al., Eds., pp. 2154–2155, McGraw-Hill, New York, NY, USA, 8th edition, 2001.
R. A. Terkeltaub, “Gout,” The New England Journal of Medicine, vol. 349, no. 17, pp. 1647–1655, 2003.
A. J. Luk and P. A. Simkin, “Epidemiology of hyperuricemia and gout,” American Journal of Managed Care, vol. 11, no. 15, pp. S435–S442, 2005.
L. Feijóo Lamagrande, F. Gómez Bravo, F. Mayo Martín, et al., “Localización inusual de tofo gotoso: pirámide nasal,” Cirugía Española, vol. 67, no. 5, pp. 503–505, 2000.
G. Navarrete Franco, B. Beirana Palencia, B. Bengoa Inzunza, A. M. Champet, and C. María Siu, “Tofos gotosos,” Rev Cent Dermatol Pascua, vol. 18, no. 3, pp. 92–95, 2009.
A. J. Reginato, “Gota y otras artropatías microcrisltalinas,” in Harrison: Principios de Medicina Interna, D. l. Kasper, A. S. Fauci, et al., Eds., McGraw-Hill, Madrid, Spain, 16th edition, 2005.
P. Arevalo, P. Briones, S. Enrique Loayza, and I. Enrique Uraga, “Frecuentes e inusuales localizaciones de tofos en la piel,” Revista Médica de Nuestros Hospitales, vol. 3–6, no. 14, pp. 27–30, 2009.