North Korean leader Kim Jong Un has been hospitalized after surgery on both ankles earlier this month, a South Korean newspaper reported.

Kim cracked bones in his ankles after neglecting an injury sustained during field supervisions in June, the Chosun Ilbo said, citing a recent visitor to North Korea it didn’t identify. The person said Kim had surgery and is recovering at Bongwha Clinic, an exclusive hospital for high-ranking party members, according to the newspaper.

Kim has not been seen in public in almost a month and missed a session of parliament on Sept. 25 for the first time since coming to power almost three years ago. In an unusual acknowledgment, North Korean state television said he was experiencing “discomfort,” and South Korea’s Yonhap News reported he is believed to be suffering from gout.

Tuesday’s report comes as Glyn Davies, the top U.S. envoy for North Korea, said the isolated state is neglecting its responsibilities to end its nuclear weapon program. Speaking in Beijing on a trip through North Asia, Davies told reporters yesterday it’s essential that North Korea moves toward denuclearization.

“Today’s news may even prompt an acceleration of North Korea’s nuclear program, and missile tests,” said Hideshi Takesada, a professor at Takushoku University in Tokyo who specializes in North Korean affairs. “He’ll probably be keen to show there are no issues in the nation’s power structure.”

The activities of North Korea’s leader are the subject of intense scrutiny in Asia and beyond because of his family’s dynastic rule, its drive to develop a nuclear arsenal and the secrecy of a regime that faces South Korea across one of the world’s most heavily-armed borders.

In fractured ankle cases, a doctor may need to set the broken bone back into place with a splint or cast, and surgery may be required to repair the break, according to WebMD, an online medical dictionary. It can take as long as two years to completely recover full pain-free motion and strength, though most people can return to a normal routine in three or four months.

Even so, speculation remains in the South Korean media that Kim may be unwell. Footage in July and earlier this month showed the country’s leader walking with a limp, and Kim appeared to have gained weight.

Surgery to the ankles could be consistent with gout, Alastair Hepburn, a consultant rheumatologist and a Medical Trustee of the UK Gout Society.

“It’s unusual but it’s possible,” Hepburn said in a telephone interview today. Severe gout can damage the joints, making an operation necessary, he said.

“Gout is a very painful and debilitating condition,” he said. “It can lead to a situation when limping becomes obvious because of the pain. A person can be quite well for some time, and then there may be sudden flare ups, which cause more pain.”

Sometimes the situation is solved, and other times, if the flare-ups keep occurring, the condition becomes chronic, Hepburn said.

Gout is a form of arthritis that isn’t fatal, though it can be agonizingly painful. The condition is caused by a buildup of a waste product in the blood called uric acid, which normally is eliminated from the body through urine, according to the U.K.’s National Health Service. Uric acid can cause needle-like crystals to form, which seep into joints and cause inflammation.

Surgery may be needed to remove gritty, chalky nodules known as tophi if uric acid crystals build up in joints, according to WebMD.

The South Korean government is cautious about making a hasty assessment of the situation given the amount of speculation over Kim’s disappearance from public view, Yonhap reported today, citing an unidentified government official. People will now be watching to see if he attends the anniversary of the Workers’ Party on Oct. 10, according to the news agency.

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