Gout can be cripple you when left untreated for years. In the US, we can give medicines to help with flares of gout as well as medicines to prevent flares and decrease the amount of uric acid in the body to prevent these deformities. Here in Peru, the medicines are available (in some places), but the access to care is the big stumbling block to better health.  All the major joints of this mans body were affected as well.