Forefoot Charcot Neuroarthropathy following Forefoot Surgery in a Non-Diabetic Patient with Myelopathy: A Rare Presentation not to be Missed.

INTRODUCTION: Charcot neuroarthropathy (CN) commonly affects the foot in diabetic patients but can also occur in patients with other conditions, such as myelopathy. It is important to recognize as it can occur and progress rapidly and is associated with significant long-term morbidity. CN can affect the forefoot although this is much rarer, and it can occur after surgery. The combination of CN affecting the forefoot following forefoot surgery in a non-diabetic patient has never been described before. We present a case report of a patient to highlight the importance of including CN in the differential diagnosis of a post-operative inflamed foot in patients with myelopathy.

CASE REPORT: A 51-year-old non-diabetic man sustained an intra-articular fracture to his second toe. It did not heal despite appropriate non-operative management over 3 months. He was discovered to have myelopathy arising from his cervical and thoracic spine. He underwent reconstructive forefoot surgery to address an arthritic bunion and the fracture but had a persistently inflamed foot post-operatively. Initially, this was suspected to be an infection, but the wounds healed well, and inflammatory markers were normal. The swelling was noted to improve on elevation and there was a significant side-to-side temperature variation. Radiographs revealed early failure of fixation and following subsequent magnetic resonance imaging scan, he was diagnosed with forefoot CN. He was treated in a total contact cast and rapidly improved. At 6 weeks, he was transitioned to a boot and underwent staged spinal surgery to address the myelopathy. By 5 months post-operatively, his foot had recovered and there was no longer a side-to-side temperature difference. By 10-month post-operatively, he was able to return to light jogging with a pain-free, well-corrected foot.

CONCLUSION: CN affecting the forefoot is rare, particularly in the setting of myelopathy in the non-diabetic patient. It can, however, be triggered by forefoot surgery. It is important to be aware of this potential diagnosis as if it is diagnosed and treated early, rapid resolution can occur, but if missed, it could potentially result in long-term complications.