56-year-old man with wound to the left first and second toe, history of diabetes mellitus, radiograph concerning for first phalanx subacute transverse fracture. There is abnormal signal intensity throughout the distal phalanx of the left great toe with gas density in the marrow space indicating osteomyelitis. Disruption of the cortical surface may represent a nondisplaced fracture as suggested on recent radiographs. There is abnormal signal within the subcutaneous soft tissues of the left great toe indicating edema. There is also enhancement within the subcutaneous soft tissues of the great toe. Foci of signal void dorsal to the distal and proximal phalanges indicate gas, possibly with a few additional small foci of gas density extending proximally along the flexor hallucis longus tendon. There is a small erosion of the medial aspect of the head of the proximal phalanx, although this may be chronic in etiology as we see no underlying marrow edema.Mild hallux valgus deformity affects the first MTP joint. There is a small amount of fluid within the first MTP joint .There is mild signal abnormality and enhancement within the soft tissues of the tip of the second toe, suggesting edema. There is also mild signal abnormality within the distal phalanx of the second toe and we cannot exclude the possibility of early osteomyelitis.There is edema within the dorsal subcutaneous fat as well as the musculature of the foot. The phalanges of the third, fourth and fifth toes are normal in appearance.
1.Osteomyelitis of the distal phalanx of the first toe with subcutaneous gas in the dorsal soft tissues.2.Equivocal early osteomyelitis of the distal phalanx of the second toe.