In this foot Xray, focus on the thumb! There are large soft tissue swellings around the metatarsophalangeal and interphalangeal joints. These are most prominent during acute gout flare. Tophi deposition also causes soft tissue swelling. The bones appear to be punched out or mouse bitten at the joints. These erosive lesions with overhanging margins are quite characteristic of the disease. Credits: http://learningradiology.com/notes/bonenotes/goutpage.htm