Hi,Dear thanks for the query to HCM virtual clinic. I studied your query in full details updated from you.I understood your health concerns. Based on your query data, In my opinion ,Dear You seem to suffer from Gouty arthritis of the left big toe with white gouty tophi with dark spot of damaged toe tissue from the gouty tophi inflammatory process involved with it. Thus this is not a infected lump but a lump with a Gouty arthritis with acute redness due to inflammation of the big toe joint cartilages and bones. They are caused by monosodium urate crystal deposition in joint cartilage of the big toe and are basically due to very high levels of Blood Uric Acid. Treatment- Investigation-and confirm- Would be by Ortho-Surgeon who would fix the cause from above possibilities and would get USG / CT to understand the nature of the painful lump of the left big toe. Blood Uric Acid levels need to be done. Xray of the left foot with big toe would fix primary diagnosis. Medicines to Reduce Uric Acid levels- Medicines like-Probensisn(to increase urinary excetion) and febuxostat(to reduce the production of Uric Acid) are used to treat Gout to bring its levels to 6 mg/ml -HIgh fluid intake with Fruesemide(lasix) to help increased excretion of Uric acid through urine. -Low Purine Diet-with avoidance of red meat/sea food and alcohol ,which increase Uric Acid levels. -NSAID like Naproxen/Motrin to reduce pain and redness -IF Gout is advanced -Surgical Removal of the Gouty arthritis may be needed For this treatment initially Physician and later on Ortho-Surgeon team would be needed to treat your case. Hope this reply would help you to evaluate your case and treat it with your doctors in time to come. Hope this would resolve your query and worry and Anxiety accompanied with it. Welcome for any further query in this regard to ME.I would love to help you out. Awaiting for any further query. Wish you fast recovery from this intriguing health problem. Have a Good Day. Dr.Savaskar M.N. M.S.Genl-CVTS -Senior Surgical Consultant