Reason: assess for osteomyelitis History: Right plantar foot ulcer, fever, pain. There is ulceration of the soft tissues beneath the first MTP joint. There is abnormal signal intensity and enhancement of the underlying subcutaneous fat, reflecting inflammation. There is a track which extends from the ulcer to and around the flexor hallucis longus tendon with abnormal signal intensity and enhancement of the sesamoid bones, compatible with osteomyelitis. There is also a small amount of fluid between the first and second metatarsals heads. We cannot determine if this reflects a mild bursitis or if this communicates with the aforementioned sinus. We see no fluid tracking along the flexor hallucis longus tendon. Moderate osteoarthritis affects the first MTP joint. There is mild signal abnormality and enhancement within the marrow of the first metatarsal head as well as fluid within the first MTP joint, but it is difficult to determine if this represents infection or simply the sequela of osteoarthritis. The phalanges of the great toe appear intact. The remaining metatarsals and phalanges appear intact. Osteoarthritis affects the midfoot with subchondral cyst formation within the lateral cuneiform. There is edema of the dorsal subcutaneous fat of the forefoot and midfoot. There is also mild edema type signal within the musculature of the foot which may reflect subacute atrophy, which is not uncommonly seen in diabetic patients.
Ulceration beneath the first MTP joint with inflammation of the soft tissues and findings compatible with osteomyelitis of the sesamoid bones beneath the first metatarsal head. There is signal abnormality within the first metatarsal head and a small amount of fluid within the first MTP joint, which could also reflect infection or simply the sequela of osteoarthritis.