Reason: evaluate for osteomyelitis, hx osteo s/p amputation left 4th and 5th toes History: dorsal foot wound The fourth and fifth toes have been amputated. There is a band of intermediate signal intensity which extends from the dorsolateral margin of the forefoot to the osteotomy margins of the fourth and fifth metatarsals, presumably representing scar tissue, which shows some enhancement following gadolinium administration. The osteotomy margins, however, appear sharp and we see no findings to suggest osteomyelitis. There is ulceration of the plantar soft tissues beneath the third metatarsal head. There is replacement of the underlying subcutaneous fat with intermediate signal intensity which likely represents a combination of edema and scarring that extends to the plantar aspect of the head of the third metatarsal. There is minimal edema within the head of the third metatarsal as well as minimal enhancement, but we suspect this represents reactive osteitis rather than osteomyelitis as the signal intensity remains relatively preserved on T1-weighted images. There is signal abnormality within the base of the second metatarsal that was present on the prior study and we suspect represents an old fracture. There is a hallux valgus deformity and mild osteoarthritis of the first MTP joint, but we see no specific findings of osteomyelitis of the bones of the first ray. There is a small amount of fluid between the second and third metatarsals which may represent a mild bursitis of questionable significance. There is increased signal intensity within the musculature of the foot on T2-weighted images with enhancement following gadolinium likely representing a combination of atrophy and inflammation, but we see no rim-enhancing fluid collection to suggest abscess formation. Mild osteoarthritis affects the midfoot.
Surgical changes of fourth and fifth toe amputation with soft tissue ulceration and scarring as described above. There is mild signal abnormality and enhancement of the head of the third metatarsal which is favored to represent reactive osteitis rather than osteomyelitis. These findings were relayed to Dr. Payne by phone at 12:35 PM on 1/11/2016.