58-year-old male with diabetic foot ulcer, cellulitis and elevated inflammatory markers evaluate for left fifth toe osteomyelitis. There is ulceration of the soft tissues along the dorsolateral aspect of the fifth toe. There is a biphalangeal fifth toe with abnormal signal intensity and enhancement of the tuft of the distal phalanx, highly suggestive of osteomyelitis. There is mild edema on fluid sensitive sequences within the base of the distal phalanx with preserved fat signal intensity on T1-weighted images likely representing reactive osteitis. We see no additional foci of osteomyelitis. There is swelling of the soft tissues of the little toe. There is soft tissue edema along the dorsum of the foot. There is increased signal intensity within the plantar musculature of the foot which may reflect mild inflammation and atrophy, but is commonly seen in diabetic patients. We see no rim-enhancing fluid collection to indicate abscess formation.
Findings highly suggestive of osteomyelitis of the tuft of the distal phalanx of the fifth toe. These findings are related to Dr. Natelborg, Christina at 5149, via text page at 6:00 PM on 11/3/2015.