Reason: osteo History: purulent foot ulcer There are multiple ulcerations along the dorsal and plantar surfaces of the mid and forefoot extending deep to the ossific margins with overlying extensive soft tissue swelling, skin thickening, and multiple punctate foci of gas. The osteotomy margins appear grossly intact yet along the inferior aspect of the base if 1st metatarsal remnant there is an enhancing focus demonstrating T1 hypointense and T2 hyperintense signal; correlating with a questionable area on the plan film of cortical indistinctness. The other remaining digits laterally demonstrate post-surgical changes from the transmetatarsal amputation of the 2nd through 5th digits. There is an additional area of abnormal T1 hypointense, T2 hyperintense signal and enhancement concerning for additional infection underlying more pronounced soft tissue changes and a deep fluid containing cleft overlying the mid-foot to the base of the 3rd metatarsal. A third and more prominent area of enhancement is proximal in the midfoot and observed along the bases of the 3rd and 4th metatarsals and extending to the cuneonavicular articulation, with extension of abnormal and suspicious signal into the body of the navicular. The calcaneus and talus appear spared.
Abnormal MR signal and enhancement throughout the mid and forefoot with overlying ulcerations, indicating extensive osteomyelitis. See locations and areas described.