RTA ankle fracture and now HAV!!!

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Hello again fellow podiatrists!!
I have a case study to discuss and could do with a little help as you have been so helpful in the past few days! A 50yr old gentleman had surgery for his fractured right ankle following an RTA 10yrs ago. Since then he has been experiencing sharp shooting pains in the 1st MTPJ with gradual deterioration. It has significantly worsened over the past few months, and he now has difficulty walking long distances. He has a grade III R HAV with overlying bursa and hammering of the R 2nd digit. Also his mother had bilateral HAV.
Why would ankle surgery cause the onset of HAV?
Any input would be appreciated!!
Thanks from your new collegue the newly qualified podiatrist!!!

 

Hello:
Good question!
A few things are possible: Along with his fractured ankle he may have had a undiagnosed injury to the forefoot.
Depending on the type and extent of his ankle injury, this may have resulted in a rearfoot valgus or marked pronation, i.e., instability of the 1st MTPJ.
If he was immobilized the cast might be the culprit.
If he fractured his ankle, did he damage his knee or hip?
Let us know what you find out.
ALSO: You do mention the Fx was 10 years ago......all things being equal the two may not be related.
Dr. Steve