Foot pain, left and right. Open wound of left foot. Drainage, pus, warmth. History of osteomyelitis. Evaluate for osteomyelitis. Left foot: Surgical changes of transmetatarsal amputation appear similar to those seen on the prior study. Overall, the margins are sharp, although there is wispy bone formation along the distal end of the remaining fifth metatarsal that corresponds approximately to signal abnormality seen on an MRI examination from July 27. While this could represent osteomyelitis, it appears similar to that seen on the radiographs from July 26, without evidence of progression.Right foot: Surgical changes of transmetatarsal amputation appear similar to those seen on the prior study. I see no frank osteolysis to suggest osteomyelitis. There is a defect in the soft tissues beneath the tarsometatarsal joint on the lateral view that likely represents ulceration that appears smaller than that seen on the prior study.
Surgical changes of bilateral transmetatarsal amputation appearing similar to the prior study. Mild irregularity of the distal margin of the remaining left fifth metatarsal could represent sequela of osteomyelitis, but appears similar to that seen on the prior study without evidence of progression. Right foot soft tissue ulceration without specific radiographic features of osteomyelitis.