Reason: Radiographic findings consistent with osteomyelitis of the fifth metatarsal on XR, right heel with eschar/wound, OM of right heel? OM seen on XR? There is bony destruction of the head of the fifth metatarsal and base of the fifth proximal phalanx with underlying abnormal signal intensity in the adjacent bone, indicating osteomyelitis. Adjacent to the fifth MTP joint is a collection of fluid signal intensity, measuring 2 cm in cross-section and 2 cm in longitudinal dimension, likely representing an abscess that perhaps communicates with the fifth MTP joint. The middle and distal phalanges of the fifth toe and remaining phalanges appear normal. There is mild signal abnormality in the head, neck, and distal diaphysis of the first metatarsal that may be degenerative in etiology or perhaps represent bone infarction but we see no adjacent soft tissue defect to suggest osteomyelitis. The bones of the midfoot appear normal. There is ulceration with reticulation of underlying subcutaneous fat of the posterior soft tissues of the heel with minimal edema of the inferomedial aspect of the posterior calcaneal tuberosity that we suspect reflects reactive osteitis rather than osteomyelitis. There is edema of the subcutaneous fat along the dorsum of the foot and ankle and fatty atrophy of the ankle and foot musculature.
1. Osteomyelitis of the fifth metatarsal head and base of the proximal phalanx with adjacent abscess perhaps arising from the fifth MTP joint.2. Heel ulceration with mild signal abnormality in the calcaneus which we suspect represents reactive osteitis rather than osteomyelitis.