Reason: osteomyelitis at based of proximal phalanx based on XR, evaluate for additional source of infection (abscess, additional foci of osteomyelitis) History: as above Note is made of soft tissue irregularity along the plantar aspect of the fifth MTP joint consistent with patient's known history of ulceration. There is increased subcutaneous and soft tissue signal abnormality/inflammatory change in the surrounding area which extends to the level of the base of the proximal phalanx of the fifth toe and also extends posteriorly to the level of the fifth MTP joint. There is increased signal abnormality within the base of the proximal phalanx on fluid sensitive sequences with corresponding decreased signal abnormality on T1-weighted images indicating osteomyelitis. There is increased signal abnormality within the head of the fifth metatarsal on fluid sensitive sequences without corresponding decreased T1 signal abnormality likely reflecting reactive osteitis. There is fluid within the fifth MTP joint which may represent a very mild synovitis. No encapsulated fluid collection is identified to suggest abscess formation. There is increased signal abnormality within the base of the fourth metatarsal which likely represents degenerative change and subchondral cyst formation. There is increased signal abnormality within the distal phalanx of the great toe without corresponding decreased T1 signal abnormality, likely representing reactive osteitis or degenerative change. There is nonspecific subcutaneous edema about the imaged portions of the midfoot/forefoot most pronounced along the dorsal aspect of the tarsals and metatarsals. There is fluid within the first MTP joint which may represent a mild synovitis.
Findings indicating osteomyelitis of the proximal phalanx of the fifth toe of the left foot and other findings as described above. No drainable abscess is identified.