Reason: Assess for foot abscess, osteomyelitis, foot as source of possible bacteremia History: No ulcers/soft tissue defects of the foot; significant swelling and pain; evidence of Charcot arthropathy on XR As seen on the recent radiographs, there are findings compatible with a neuropathic arthropathy of the tarsometatarsal joints with cyst/erosions of the metatarsal bases, cuneiforms, and cuboid. There is also fluid within the Lisfranc joint and abnormal signal intensity within the adjacent bones representing edema associated with the arthropathy. The bone fragments within the adjacent soft tissues are better seen on the patient's recent radiographs. There is also a fluid collection along the lateral aspect of the talonavicular joint, perhaps arising from the sinus tarsus. There is diffuse edema particularly along the dorsum of the forefoot and midfoot. Although there is edema within the subcutaneous fat of the forefoot and midfoot, we see no soft tissue defect or sinus tract extending from the skin to the bone to suggest osteomyelitis. There is diffuse atrophy of the imaged musculature of the midfoot and forefoot as well.
Soft tissue edema and neuropathic arthropathy of the Lisfranc joint. There is also a small fluid collection along the lateral aspect of the talonavicular joint that may represent a synovial cyst or ganglion. While it is impossible to completely exclude infection, we see no soft tissue ulceration, sinus tracts, or other specific findings to support abscess formation or osteomyelitis.