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We present a case of sea urchin spine arthritis (SUSA) in a 33-year-old woman who sustained penetrating trauma to the interphalangeal (IP) joint of the hallux while snorkeling in Japan. Serial radiographs and MRI were obtained over a period from 7 weeks to 10 months following injury. At 7 weeks radiographs revealed periarticular osteopenia and subtle marginal erosion, similar to the appearance of tuberculous arthritis. Over the ensuing months, radiographs and MRI documented progressive marginal and periarticular erosions with synovitis, despite preservation of cartilage space and restoration of bone mineral density. Delayed radiographs and imaging features mimic gouty arthropathy. Only the history points to the proper diagnosis, which was confirmed by histopathology, demonstrating necrobiotic granuloma with central fibrinoid necrosis following synovectomy and arthrodesis. The majority of previous case reports affected the hand, with few cases in the feet. In all, radiographic illustrations were limited and demonstrated only minimal osteolysis and periosteal reaction. No other report included MRI or serial radiographs over a long period to illustrate the natural progression of the disease.