59-year-old female with history of pain. There is moderate soft tissue swelling and ulceration particularly along the medial aspect of the great toe. There is mild irregularity along the medial aspect of the base of the distal phalanx which may represent acute osteomyelitis, but given the findings on the prior MRI from 3/2015, this may represent sequela of chronic osteomyelitis instead. We see no frank bone destruction to confirm acute osteomyelitis. Mild osteoarthritis affects the interphalangeal and first MTP joints.
Mild irregularity along the medial aspect of the base of the distal phalanx may represent acute osteomyelitis, but given the findings from the MRI from 3/2015, this may represent sequela of chronic osteomyelitis. If there is strong clinical concern for acute osteomyelitis, MRI may be obtained.