Cellulitis and foot ulcer The fourth metatarsal and a portion of the proximal phalanx have been resected as seen on prior radiographs. There is abnormal signal intensity on both T1 and T2 sequences within the remaining base of the fourth metatarsal as well as the second, third, and fifth metatarsals proximally which contains several small rounded foci of enhancement. A chronic appearing erosion is also noted at the head of the third metatarsal. The signal intensity of the first metatarsal is normal. There is also abnormal signal intensity and enhancement of the bones of the midfoot with multiple subchondral cysts/erosions, some of which enhance following gadolinium administration. Bony fragments dorsal to the midfoot are better seen on recent radiographs. There is mild edema and enhancement of the adjacent/surrounding soft tissues but we see no discrete overlying wound or sinus tract extending to the midfoot. Although we cannot completely exclude a superimposed infection, these findings are more in keeping with neuropathic arthropathy. There is a small collection of rim-enhancing fluid dorsal to the medial cuneiform which we suspect represents a synovial cyst or ganglion about the cannot entirely exclude a small abscess. The signal intensity of the phalanges is normal and there is mild edema and enhancement lateral to the distal phalanx of the fifth toe which may reflect focal inflammation. Note is made of a bipartite lateral sesamoid which is a normal variant.
1. Abnormal signal intensity of the bones of the midfoot and metatarsal bases as described above. Although it is impossible to exclude superimposed infection, the regional nature of these findings is more in keeping with neuropathic arthropathy. If there is strong clinical concern for osteomyelitis, a tagged white blood cell scan can be considered.2. Additional findings described above.