Female 58 years old Reason: patient presents with left plantar foot ulcer; evaluate for osteomyelitis History: left foot ulcer There is ulceration of the soft tissues of the ball of the foot beneath the first metatarsophalangeal joint. Best seen on postcontrast sequences there is what appears to be a nonenhancing tract extending from the ulcer toward both hallux sesamoid bones. There is edema and enhancement of adjacent soft tissues indicating inflammation. There is abnormal signal and enhancement in the medial sesamoid bone consistent with osteomyelitis although we see no frank cortical destruction. There is also low signal intensity within the lateral sesamoid on T1 images which may also represent osteomyelitis although this is less likely as there is no edema seen on the STIR sequence. Signal intensities of the metatarsals is normal. Signal intensity of the first through third toe phalanges is normal. Evaluation of the fourth and fifth toes is limited due to metallic susceptibility artifact, likely from foreign body in the fifth toe.There is enhancement of the sheath of the flexor hallucis longus as it courses beneath the first proximal phalanx and first metatarsal indicating tenosynovitis with a tiny amount of fluid, particularly distally. Atrophy of the plantar muscles of the foot is noted. There is mild increased STIR signal in the muscles which may represent mild edema.
1.Ulceration of the base of the great toe with underlying inflammatory changes in the soft tissues.2.Signal abnormality of the hallux sesamoid bones, with changes compatible with osteomyelitis in the medial sesamoid bone, and findings equivocal for osteomyelitis in the lateral sesamoid bone.3.Tenosynovitis of the flexor hallucis longus tendon which could represent infection.