Suspicious for osteomyelitis on foot xray, probe to bone, diabetic foot infection. Question of osteomyelitis. There is heterogeneous T1 signal and increased STIR signal within the head to midshaft of the first metatarsal. This region also enhances on post-contrast imaging and is compatible with osteomyelitis. There is destruction of the head of the first metatarsal.There is hypointense T1/hyperintense STIR signal within the fourth digit proximal phalanx with associated enhancement and cortical destruction, which is also compatible with osteomyelitis. There is a soft tissue defect dorsal to this as well. There is mild increased STIR signal and enhancement of the head of the third metatarsal with slightly decreased T1 signal which is also highly suspicious for osteomyelitis. There is a chronic fracture of the midshaft of the second metatarsal with surrounding intermediate signal. There is a 8 x 28 mm T1 hypointense/T2 hyperintense collection adjacent to the head of the first metatarsal with rim enhancement which likely represents an infected fluid collection. There is diffuse soft tissue edema/inflammatory changes of the forefoot.
1. Osteomyelitis of the first metatarsal, fourth digit proximal phalanx, and third metatarsal as described above with surrounding inflammation.2. Infected fluid collection adjacent to the first metatarsal head. 3. Fracture of the second metatarsal. 