Patient with 4 weeks of worsening left great toe pain. Obvious dry gangrene. Question is extent of underlying infection to decide on level of amputation and debridement. There is extensive low T1/high T2 signal of the distal phalanx of the great toe with cortical disruption compatible with osteomyelitis. Signal changes also involve the distal aspect of the proximal phalanx of the great toe, also demonstrating cortical destruction. The remainder of the bones are spared. There is enhancement of the first metatarsophalangeal joint, compatible with synovitis.Soft tissue gas extends proximally to the level of the metatarsal bases on the dorsum of the foot. There is no evidence of abscess.
1.Signal changes and cortical destruction of the distal phalanx of the great toe, extending in to the distal aspect of the proximal phalanx, compatible with osteomyelitis.2.Enhancement of the first metatarsophalangeal joint, compatible with synovitis.