Ankle wound There is a large soft tissue defect along the posteromedial aspect of the ankle with replacement of the underlying subcutaneous fat with abnormal signal intensity likely reflecting a combination of inflammation and scarring. There is a poorly defined collection of abnormal signal intensity anterior to the wound just posterior and medial to the medial malleolus that could represent phlegmon. Small foci of signal void within this collection may represent gas and suggest communication with the above-described ulcer.Additional soft tissue ulceration is noted lateral to the distal fibula with replacement of the underlying subcutaneous fat with what is likely a combination of scarring and inflammation. A 1 cm collection of fluid signal intensity within the subcutaneous fat just anterior to this soft tissue defect could represent a small abscess with possible communication with the nearby ulceration. Edema extends within the subcutaneous fat superiorly from the ulceration along the peroneal muscles beyond the field-of-view but we see no definite intramuscular abscess. Abnormal signal intensity also extends anteromedially to the lateral margin of the calcaneus where there is abnormal marrow signal on both T1 and T2 sequences suggesting underlying osteomyelitis. Additional small foci of signal void within the inflamed soft tissues of the ankle likely reflect gas.There is a small tibiotalar joint effusion with small foci of edema in the underlying tibial plafond and talar dome. These findings are nonspecific and may be reactive in nature but we cannot exclude the possibility of an infected ankle joint, although we see no definite direct communication between the joint and the above-mentioned ulcerations.Mild edema is noted within the distal fibula (seen on the fat-suppressed T2 sequences) which is thought to represent reactive osteitis as opposed to true osteomyelitis given the normal fatty marrow signal on the T1W sequences. The marrow signal of the midfoot and proximal metatarsals is normal. There is mild edema within the plantar musculature and moderate edema of the dorsal subcutaneous fat. The ankle tendons and ligaments are intact.
1. Extensive ulceration of the soft tissues of the ankle with inflammation of the underlying soft tissues further detailed above. This inflammation extends to the superolateral margin of the body of the calcaneus where there is abnormal signal intensity of the underlying marrow compatible with osteomyelitis.2. Mild edema type signal involving the distal fibula which is favored to represent reactive osteitis as opposed to osteomyelitis.3. Small tibiotalar joint effusion with small foci of edema in the adjacent tibial plafond and talar dome. Although the effusion and marrow edema may be reactive in nature, we cannot entirely exclude the possibility of a septic arthritis.These findings were discussed with resident physician Dr. T. Wagner of the primary service at the time of final interpretation.