Tophi are not seen in which of the pa of the body?

Gout is inflammation caused by monosodium urate monohydrate (MSU) crystals. The biochemical hallmark of gout is the elevation of serum urate levels. The tophus is the pathognomonic lesion of gout and is essentially a foreign body granuloma. Tophaceous deposits appear in cailage, ligaments and tendons, bursae, and synol membranes and other periaicular soft tissues at a rate equal to the degree and duration of hyperuricemia. Tophi are frequently seen in the external ear and pressure points over the elbows, hands, feet, knees, and forearms. Tophi may ulcerate and express whitish, chalky material. Although painless, their presence ultimately can limit joint motion. As they become larger, tophi may calcify or ossify and produce tendon rupture, nerve compression, and/or paralysis.