Male, 47 years old. Necrotic diabetic ulcer at base of R great toe w/ surrounding cellulitis. There is extensive ulceration of the great toe with edema and enhancement of the underlying soft tissues, particularly medially, indicating inflammation. There is abnormal signal intensity throughout the distal phalanx of the great toe which is hypointense on T1 and hyperintense on T2, compatible with osteomyelitis. There are cysts in the base of the proximal phalanx, but we see no marrow edema to suggest osteomyelitis of the proximal phalanx. The phalanges of the lesser toes appear normal. Aside from mild subchondral degenerative changes, signal intensity in the metatarsals is normal. There is a bipartite medial sesamoid bone. The marrow signal intensity of the medial sesamoid bone is low on T1-weighted images with small cysts noted within the proximal fragment on T2-weighted images. This could reflect osteonecrosis, but it appears chronic. Mild degenerative changes affect the Lisfranc joint. Mild edema within the medial cuneiform is nonspecific but may be degenerative in etiology. There is atrophy of the musculature of the forefoot. There is edema along the dorsum and within the medial soft tissues of the forefoot, but we see no focal fluid collection to suggest an abscess.
Osteomyelitis of the distal phalanx of the great toe and other findings as described above.Findings were discussed via telephone with Dr. Vasishta at 1:35 PM on 05/13/2016.