Aim and background: Charcot neuroarthropathy is a disabling disorder affecting a large number of diabetics all over the world. It most commonly involves the midfoot. Forefoot Charcot is rare. The affection of the hallux is not usually seen. A case of isolated first metatarsophalangeal (MTP) joint disease with a valgus deformity managed surgically by arthrodesis has been described.
Case description: A 52-year-old male patient presented with bilateral hallux valgus, left more than right, and a callosity over the plantar aspect of the left first MTP joint. Standard weight-bearing radiographs revealed osteolysis and osteophytes pointing toward Charcot arthropathy. A diabetic foot assessment further supported our diagnosis. The patient underwent the first MTP joint fusion using a locking plate. No intraoperative and postoperative complications were noted. Nonweight-bearing mobilization was followed for 6 weeks, followed by gradual weight-bearing over 2 weeks. An 8-week and 4-month follow-up revealed corrected deformity and healed callosity.
Conclusion: Forefoot is a rare location of Charcot disease. Hallux valgus is an uncommon presentation of this disorder. Soft tissue pathologies are common due to abnormal loading of the foot. These, along with joint disease, can be managed satisfactorily by arthrodesis to offload the affected region.
Clinical significance: Forefoot should not be neglected in Charcot disease. Hallux valgus in a diabetic patient must be evaluated thoroughly to rule out the neuropathic joint disorder.
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