30-year-old female with diabetes and end-stage renal disease with severe callus over third metatarsal head. Concern for osteomyelitis on recent radiographs. There is soft tissue ulceration along the plantar aspect of the third MTP joint which extends dorsally to the level of the third metatarsal head. There is increased signal abnormality on fluid sensitive sequences with decreased signal abnormality on T1-weighted images within the head of the third metatarsal extending proximally to the mid diaphysis consistent with osteomyelitis. There is erosion about the first and second MTP joints particularly involving the lateral aspect of the first metatarsal head, which may reflect the sequela of chronic osteomyelitis. There is deformity about the base of the second metatarsal with signal abnormality in the surrounding area likely representing a healing fracture through the base of the second metatarsal with exuberant callus formation. There are also fracture deformities through the proximal aspect of the fourth and fifth metatarsals with slight medial angulation of the distal fracture fragments. The patient is status post amputation through the PIP joint of fifth digit of the right foot. No focal fluid collection is identified to suggest abscess formation. There is nonspecific increased signal abnormality within the calcaneus and cuboid as well as the remainder of the tarsal bones on fluid sensitive sequences which may represent a combination of reactive osteitis and degenerative change.
1. Findings consistent with acute osteomyelitis of the third metatarsal as described above. Erosions about the first and second MTP joints may represent the sequela of chronic osteomyelitis. 2. Fracture deformity of the second, fourth, and fifth metatarsals as described above. Other findings as described above.