Reason: osteomyelitis of the right History: cellulitis, pain Patient motion artifact limits evaluation on multiple sequences. The first toe has been amputated through the first metatarsal. The underlying osteotomy margins are sharp without evidence of osteomyelitis. There is plantar and medial displacement of the middle phalanx of the second toe relative to the proximal phalanx. There is tapering of the head of the proximal phalanx with abnormal signal intensity within the proximal phalanx most concentrated at the head indicating osteomyelitis. There is abnormal signal intensity within the soft tissues dorsal to the head of the proximal phalanx likely representing ulceration. There is also abnormal signal intensity within the subluxed/dislocated middle phalanx most concentrated at its base compatible with osteomyelitis. There also appears to be ulceration dorsal to the distal phalanx. As seen on the prior radiographs, the tuft of the distal phalanx is absent which may be chronic in etiology. The fatty signal intensity of the base of the distal phalanx appears preserved. The remaining phalanges and metatarsals appear intact as do the tarsal bones. There is subcutaneous edema extending along the dorsal soft tissues of the forefoot and midfoot. There is atrophy of the plantar musculature of the foot.
Osteomyelitis of the proximal and middle phalanges of the second toe. Absence of the tuft of the distal phalanx of the second toe may reflect prior surgery or long-standing infection.