Atraumatic fracture of proximal first phalanx

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Figure. A 50-year-old man with a history of gout presented with a tender, swollen, red great toe of 2 weeks' duration.

The patient was found to have a normal uric acid level but an elevated random glucose level (17 mmol/L, normal 3.9–6.1 mmol/L). Type 2 diabetes was diagnosed. The patient then admitted to a 7-year history of diabetes, with little treatment, and was found to have bilateral peripheral neuropathy and decreased sensation in his feet. He had no history of trauma that he could recall. The patient also admitted to drinking up to 5 drinks of alcohol a day for several years, a risk factor for neuroarthropathy.1

The differential diagnosis for an acute monoarthritis of the first phalangeal joint includes gout, pseudogout, infection, osteomyelitis, cellulitis, trauma and fracture. Besides fracture, other common diabetic foot lesions include osteolysis, osteoporosis, osteosclerosis, juxtra-articular defects of the cortical bone, new bone formation and sclerosis of the shaft, ischemic bone necrosis, subluxation and neuropathic arthropathy.

A radiograph of the patient's foot revealed a fracture in the first phalanx (Fig. 1, arrow). The patient responded well to 4 weeks of casting and oral antihypertensive and hypoglycemic therapy.

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Figure.