Foot ulcer There has been amputation of the first ray at the tarsometatarsal joint. There is absence of the distal half of the second metatarsal presumably secondary to surgical resection as well. There is destruction of the head of the proximal phalanx and base of the middle phalanx of the second toe with associated edema and enhancement indicating osteomyelitis. There is surrounding soft tissue inflammation with what may be a tract extending from the PIP joint to the dorsal surface of the great toe. Furthermore, there is additional edema/enhancement within the distal phalanx of the second toe suspicious for osteomyelitis.There is deformity of the third metatarsal which is likely secondary to prior trauma and/or the sequela of old infection. There is a soft tissue defect overlying the distal phalanx of the third toe with abnormal signal intensity and enhancement of the underlying distal phalanx, suspicious for osteomyelitis. The marrow signal of the fourth ray appears normal with no evidence of osteomyelitis.There is a soft tissue defect or blister along the the fifth toe with minimal signal abnormality in the middle and distal phalanx. This signal abnormality is favored represent reactive osteitis as opposed to true osteomyelitis.There is diffuse soft tissue edema of the dorsal foot with mild increased signal intensity of the plantar musculature which may reflect subacute atrophy. There is no discrete fluid collection identified.
1. Osteomyelitis of the proximal, mid, and likely distal phalanges of the second toe.2. Probable osteomyelitis of the distal phalanx of the third toe.3. Soft tissue defect/blister of overlying the fifth toe with signal abnormalities in the distal and middle phalanges suggestive of reactive osteitis as opposed to true osteomyelitis.4. Additional findings described above.These findings were discussed with CNP M. Jacobs of the primary team at the time of dictation.