Reason: 74F with non-healing worsening ulcer over her lateral right ankle. Concern for osteo History: worsening pain and size of ulcer 2 skin markers overlie the lateral aspect of the ankle. Note is made of soft tissue irregularity along the lateral aspect of the distal tibia consistent with patient's known history of ulceration. There is subcutaneous edema in the underlying area likely representing cellulitis. There is interval development of periosteal reaction along the lateral aspect of the distal fibula as well as interval increase in bone marrow signal abnormality in the underlying fibula with associated decreased signal abnormality on T1-weighted images. While some of this new bone marrow signal abnormality may reflect reactive bone marrow edema, the presence of periosteal reaction and decreased T1 signal abnormality indicates osteomyelitis. There is heterogeneous bone marrow signal abnormality likely representing residual islands of red marrow. There is increased signal abnormality within the anterior calcaneus about the calcaneocuboid articulation likely representing degenerative changes. The peroneal tendons appear intact. The anterior tendons appear intact. There is a small amount of circumferential fluid within the tendon sheaths of the posterior tibialis, flexor digitorum longus and flexor hallucis longus which may represent a very mild tenosynovitis. There is nonspecific increased signal abnormality within the plantar musculature of the foot which can be seen in diabetic patients.
Interval development of increasing bone marrow signal abnormality and periosteal reaction within the distal fibula suspicious for osteomyelitis. Other findings as described above.