Hallux gangrene following first metatarsophalangeal arthrodesis

Hallux 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.