A 55-year-old female patient with type 2 diabetes diagnosed at the age of 40 years, treated with insulin, and erratic glycemic control, visited the diabetic foot clinic because of recurrent callus formation. She had background retinopathy, hypertension, and severe peripheral neuropathy, and a history of amputation of her left second toe 3 years previously due to osteomyelitis after a perforated ulcer.
After removal of her second toe, her left great toe gradually dislocated to a val-gus posture, underriding the adjacent (third) toe (Figure 3.28). Gross callus formation developed at the medioplantar aspect of the first metatarsal head, which caused constant discomfort during walking and dancing (Figure 3.29). Callus was also noticed over the third metatarsal head.
At the outpatient clinic the callosity was removed and a full thickness ulcer revealed. More callus built up quickly as a result of the very active lifestyle of the patient and her refusal to wear appropriate footwear, she therefore had to attend the clinic every week.
A plain X-ray showed disarticulation of the left second toe, dislocation of the
metatarsophalangeal joint of the great toe, medial pronation of the first metatarsal head, and hallux valgus deformity with rotation, together with dislocation of the sesamoids, and arthritis; necrosis of the head of the third metatarsal bone was also evident (Figure 3.30).
After the operation there was no significant callus development within the next 3 months (Figure 3.31).
Keywords: Hallux valgus; prophylactic surgery; second ray amputation
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