43 year old male with DM and right ankle pain with elevated CRP. Rule out osteomyelitis. The great toe appears to been amputated, although this region is not included on the study. There is a large plantar soft tissue defect beneath the remaining first metatarsal extending proximally to beneath the anterior margin of the calcaneus and distally off of the field-of-view of this study. There appears to be blister formation along the adjacent skin of the plantar surface of the foot and there is replacement of the adjacent subcutaneous fat that presumably represents a combination of edema and scarring. There is also edema of the plantar musculature of the foot, indicating inflammation, with small foci of signal void that presumably represent foci of inter/intramuscular gas. The flexor hallucis longus tendon extends to the ulcer, beyond which it cannot be followed. We see no signal abnormality within the bones of the ankle, midfoot, or hindfoot to suggest osteomyelitis. Osteoarthritis affects the midfoot and to a lesser degree the tibiotalar and subtalar joints. There is a subcentimeter focus of low signal intensity within the talus containing a central focus of increased signal intensity, which may represent a benign bone island. There is a small amount of fluid within the posterior recess of the subtalar joint with a linear focus of low signal intensity that may represent a cartilaginous fragment. There are small amounts of fluid also noted within the sheaths of the medial and lateral ankle tendons which may represent mild tenosynovial inflammation, but this is not necessarily of any current clinical significance. There is fatty atrophy of the visualized ankle musculature. There is subcutaneous soft tissue swelling about the ankle.
Extensive plantar soft tissue ulceration and inflammation as described above, but no specific imaging features of osteomyelitis.