[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-458825-105":59,"doc-detail-458825-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","hallux-gangrene-following-first-metatarsophalangeal-arthrodesis-case-report","Hallux gangrene following first metatarsophalangeal arthrodesis - Case Report","","Hallux rigidus is commonly treated with first metatarsophalangeal (MTP) arthrodesis, a procedure with high success and low complication rates. A rare postoperative hallux gangrene occurred in a 44-year-old woman with celiac disease and no conventional vascular risk factors. Ischemic changes began on postoperative Day 1 despite normal dorsalis pedis and posterior tibial pulses, progressing to dry gangrene and amputation at the MTP joint. Angiography showed no proximal obstruction, supporting a microvascular mechanism. Possible causes include vasospasm, small-vessel thrombosis, or autoimmune-mediated vasculitis, emphasizing early recognition and atypical etiologies after forefoot surgery.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/hallux-gangrene-following-first-metatarsophalangeal-arthrodesis-case-report/458825/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/hallux-gangrene-following-first-metatarsophalangeal-arthrodesis-case-report/458825.png","ImageObject",300,407,{"name":92,"@type":93},"Alexandar","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":14},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"How did postoperative hallux gangrene develop after first MTP arthrodesis?","Question",{"text":112,"@type":113},"On postoperative day 1, the great toe became blue and painful, then progressed despite care, ultimately resulting in dry gangrene involving the entire hallux and amputation at the MTP joint.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What vascular findings were present despite the gangrene?",{"text":117,"@type":113},"The patient had normal dorsalis pedis and posterior tibial pulses (2+), with angiography showing no proximal obstruction, suggesting a microvascular etiology rather than a correctable proximal lesion.",{"name":119,"@type":110,"acceptedAnswer":120},"What potential mechanisms and conditions were proposed to explain the case?",{"text":121,"@type":113},"The report suggests vasospasm, small-vessel thrombosis, or autoimmune-mediated vasculitis, highlighting the possible role of autoimmune disease in postoperative microvascular compromise, in the setting of celiac disease.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},458825,1790754538,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":14,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":52,"preview_page_count":4},962090768658,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Journal of Surgical Case Reports, 2026, 1, rjaf1060  \n[https://doi.org/10.1093/jscr/rjaf1060](https://doi.org/10.1093/jscr/rjaf1060)  \nCase Report  \nCase Report  \nHallux gangrene following first metatarsophalangealarthrodesis  \nNicholas Frappa 1 , *, Danil Chernov1 , Morgan Dillon 1 , Matthew G. Alben2 , Josh Slowinski2 , Gabrielle Hartman2 , Jennifer Gurske-dePerio2  \n1 Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, 955 Main Street, Buffalo, NY 14203, United States  \n2 Department of Orthopaedics and Sports Medicine, University at Buffalo, 462 Grider Street, Buffalo, NY 14215, United States  \n*Corresponding author. Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, 955 Main Street, Buffalo, NY 14203, United States. [E-mail:](E-mail: nmfrappa@buffalo.edu)[ nmfrappa@buffalo.edu](E-mail: nmfrappa@buffalo.edu)  \nAbstract  \nHallux rigidus is commonly treated with first metatarsophalangeal (MTP) arthrodesis, a procedure with high success and low complication rates. We present a rare case of postoperative hallux gangrene following first MTP arthrodesis in a 44-year-old woman with celiac disease and no conventional vascular risk factors. Despite normal dorsalis pedis and posterior tibial pulses, the great toe developed ischemic changes on postoperative Day 1, progressing to dry gangrene requiring amputation at the MTP joint. Angiography revealed no proximal obstruction, supporting a microvascular etiology. Potential mechanisms include vasospasm, small-vessel thrombosis or autoimmune-mediated vasculitis. This case underscores the importance of early recognition of digital ischemia after forefoot surgery, even in healthy patients, and highlights the possible role of autoimmune disease in postoperative microvascular compromise.  \nKeywords: hallux rigidus; first metatarsophalangeal arthrodesis; postoperative gangrene; microvascular ischemia; digital ischaemia  \nIntroduction  \nHallux rigidus, defined as degenerative arthritis of the first metatarsophalangeal (MTP) joint, is a common forefoot pathology that impairs gait and quality of life [1 , 2] . When conservative measures fail, first MTP joint arthrodesis is widely regarded asthe gold-standard surgical treatment [1 , 2] . This procedure reliably alleviates pain and corrects deformity, with fusion rates exceeding 90% and most patients reporting high satisfaction [1 , 3] .  \nAlthough generally safe and effective, complications can occur. The most frequent include nonunion, malunion, hardware irritation, infection, and delayed wound healing [4 , 5] . Vascular compromise is exceedingly rare, and to our knowledge no prior cases of postoperative gangrene have been reported after first MTParthrodesis. Only isolated reports exist following other forefoot procedures, including hallux gangrene after revision hallux valgus correction, digital necrosis after second-toe arthrodesis complicated by cryoglobulinemia, and ischemia from iatrogenic arterial injury in adolescent hallux valgus surgery [6–8] .  \nWe present a rare case of hallux gangrene following first MTParthrodesis in a healthy woman with celiac disease. While the precise mechanism is uncertain, the case illustrates that ischemia can occur despite normal vascular examinations and highlights the importance of considering atypical etiologies when perfusion deficits develop postoperatively. The patient provided consent to submit case data for publication.  \nCase presentation  \nA 44-year-old active woman, with a body mass index of 19. 7, presented with symptomatic left hallux rigidus. Her past medical history included only celiac disease; she had no history of smoking, diabetes, peripheral vascular disease, or other conventional vascular risk factors. Her sole medication was spironolactone. She underwent standard first MTP arthrodesis with articular surface preparation, demineralized bone matrix, and fixation using two headless compression screws (Fig. 1) . A tourniquet was applied ju","cbCaiulG0AIZ92SA","https://ap.wps.com/l/cbCaiulG0AIZ92SA","pdf",565111,"English","# Abstract\n# Introduction\n# Case presentation","[{\"question\":\"How did postoperative hallux gangrene develop after first MTP arthrodesis?\",\"answer\":\"On postoperative day 1, the great toe became blue and painful, then progressed despite care, ultimately resulting in dry gangrene involving the entire hallux and amputation at the MTP joint.\"},{\"question\":\"What vascular findings were present despite the gangrene?\",\"answer\":\"The patient had normal dorsalis pedis and posterior tibial pulses (2+), with angiography showing no proximal obstruction, suggesting a microvascular etiology rather than a correctable proximal lesion.\"},{\"question\":\"What potential mechanisms and conditions were proposed to explain the case?\",\"answer\":\"The report suggests vasospasm, small-vessel thrombosis, or autoimmune-mediated vasculitis, highlighting the possible role of autoimmune disease in postoperative microvascular compromise, in the setting of celiac disease.\"}]","Hallux gangrene following first metatarsophalangeal arthrodesis - Case Report | PDF"]