Reason: Eval for osteomyelitis History: Deep ulcer of Left foot plantar, head of 1st metatarsal, plantar aspect, present for years There is ulceration of the ball of the foot beneath the first MTP joint. There is intermediate signal intensity on T1-weighted images replacing the underlying subcutaneous fat which is heterogeneous on T2-weighted images and extends to the head of the first metatarsal as well as the base of the great toe, likely reflecting a combination of granulation tissue, scarring, and edema. There is chronic erosion of the head of the first metatarsal that likely represents sequela of prior infection, but we see no edema within the marrow of the first metatarsal to indicate acute osteomyelitis. There is linear signal abnormality within the proximal diaphysis of the first metatarsal that may represent a small focus of bone infarction. The proximal phalanx is dorsally subluxed/dislocated relative to the first metatarsal. There is a defect within the base of the proximal phalanx, again, likely representing an erosion from prior osteomyelitis. However, we suspect that this is chronic as we see no edema within the adjacent marrow. The distal phalanx appears normal. There are small subcutaneous foci of signal void beneath the first metatarsal head which may represent gas or metal artifact. A small amount of fluid tracks along the inferior aspect of the distal diaphysis of the first metatarsal, but the clinical significance of this is uncertain, and there is little if any adjacent soft tissue inflammation. The sesamoid bones are not visualized and are presumably surgically absent or destroyed from prior infection. The flexor tendons of the great toe are not well visualized. There is diffuse atrophy of the imaged musculature of the foot. Mild osteoarthritis affects the midfoot.
1. Ulceration of the ball of the foot near the first metatarsal head with signal abnormality within the underlying soft tissues likely representing a combination of scarring and edema. There is a small collection of fluid along the undersurface of the first metatarsal. While we cannot exclude the possibility of a small abscess, this may not be of any clinical significance due to the lack of inflammation within the surrounding soft tissues and underlying bone.2. Absence of the sesamoid bones is presumably related to prior surgery or long-standing infection.3. Erosive deformity of the head of the first metatarsal and base of the proximal phalanx is likely due to infection, but we suspect that this is chronic as we see no edema within the adjacent bone marrow. Other findings as described above. Conventional radiographs may provide additional information and are recommended for initial evaluation for osteomyelitis.