Drainage, pain. Known osteomyelitis. Orthopedic evaluation. There is thickening and sclerosis of the diaphysis of the third metatarsal, compatible with chronic osteomyelitis. The head of the third metatarsal appears separated from the diaphysis with erosion suggesting acute osteomyelitis (likely corresponding to the "abscess" seen on the recent MRI examination). Osteolysis of the proximal phalanx of the third toe also indicates acute osteomyelitis, and poor definition of the proximal margin of the middle phalanx of the third toe is suggestive of acute osteomyelitis as well. Deformity of the second metatarsal head and bases of the first, second and fourth proximal phalanges may reflect prior infection or trauma, but I see no osteolysis these bones on the current study. Moderate osteoarthritis affects the first metatarsophalangeal joint. Deformity of the head of the fourth proximal phalanx likely reflects prior surgery. Deformity of the neck of the fifth metatarsal likely reflects an old healed fracture.
Osteomyelitis of the third metatarsal, third proximal phalanx, and third middle phalanx, with other findings as described above.