Finger pad tophi are an unusual but not very rare presentation of uncontrolled gout. Unlike tophaceous lesions of other locations, finger pad tophi are often difficult to diagnose at presentation due to resemblance to a variety of nodular lesions, coexistence with other connective tissue disorders and sometimes occurrence in asymptomatic hyperuricemia. They also pose a therapeutic dilemma due to a lack of clear treatment guidelines. Several case reports of finger pad tophi have been published before, focusing mainly on diagnosis and medical management. We discuss here a case of thumb pad tophi as primary presentation of undiagnosed asymptomatic hyperuricemia and treated surgically with excision and full-thickness skin graft along with urate-lowering therapy. This article highlights the diagnosis and treatment of finger pad tophi. We also discuss the surgical management of tophaceous lesions of hands and digits.