Approach to foot pain Quiz: Ace Your Exams

A 52-year-old man presents to the urgent care clinic with severe pain in the left foot for one day. There has been marked redness and swelling of the first left toe and top of the foot since yesterday. His past medical history includes hypertension and osteoarthritis of the knees for which he takes hydrochlorothiazide and naproxen, respectively. Temperature is 37.0°C (98.6°F), pulse is 102/min, respiratory rate is 20/min and blood pressure is 140/90 mmHg. Body mass index is 32 kg/m². On examination, the patient appears to be in moderate distress due to pain. Examination of the left foot reveals erythema, warmth, and swelling at the first MTP joint and over the dorsum of the foot as seen in the image below. There is exquisite tenderness to light palpation at the first MTP joint and significant pain with passive movement of the first MTP. Which of the following additional historical elements is most likely to have contributed to the underlying condition?
 
^{Image by Gonzosft is licensed under the Creative Commons Attribution 3.0 Germany license, reproduced from WikiCommons}