34-year-old male, evaluate for osteomyelitis of the second metatarsal head and second toe of the left foot There is a defect in the plantar skin beneath the second metatarsophalangeal joint presumably representing the patient's known ulcer. Abnormal signal intensity extends from the ulcer to the underlying second metatarsal head and base of the second proximal phalanx. The signal abnormality also tracks along the flexor tendon apparatus of the second digit, with distention of the tendon sheath, likely representing septic tenosynovitis. The tenosynovitis extends from the second DIP joint to the level of the proximal diaphysis of the second metatarsal, and the flexor tendon sheath is distended by heterogeneous near-fluid signal intensity. Increased signal intensity within the plantar musculature of the forefoot and along the remaining flexor tendons beneath the midfoot suggests edema. Additional edema is present within the dorsal soft tissues along the midfoot. On the fat-suppressed T2 images there is edema in the head of the second metatarsal and in the proximal, middle, and distal phalanges of the second toe. The signal intensity appears relatively normal on T1 weighted images, however, favoring reactive osteitis rather than osteomyelitis. Edema about the base of the first TMT joint likely represents degenerative osteoarthritis. Mild osteoarthritis also affects the first metatarsophalangeal joint. Mild hallux valgus deformity.
1. Soft tissue ulceration and findings compatible with septic tenosynovitis of the flexor tendon apparatus of the second toe.2. Signal abnormality in the bones of the second toe and proximal phalanx of the third toe as described above, felt to more likely represent reactive osteitis rather than osteomyelitis.Findings discussed with Dr. Zmuda (pager 3330) at the time of dictation. 