58-year-old male with altered mental status and history of chronic osteomyelitis of the right foot. Suboptimal examination secondary to patient motion artifact and patient's inability to tolerate the examination. Again seen is ulceration along the posterior and plantar aspect of the calcaneus with signal abnormality extending to the underlying posterior tuberosity of the calcaneus. There is persistent signal abnormality within the posterior tuberosity of the calcaneus including low signal intensity on T1-weighted images and increased signal intensity on T2-weighted images, compatible with osteomyelitis, which appears less extensive on the current study than on the prior examination. However, there is now a mildly displaced Achilles tendon avulsion fracture off of the superior aspect of the calcaneal tuberosity, which is displaced anteriorly and proximally by 1 cm as seen on the recent radiographs. There is thickening of the distal Achilles tendon likely representing a combination of tendinosis and retraction. Signal intensity of the remaining visualized bones is normal. There is a small amount of fluid within the tibiotalar joint and anterior recess of the subtalar joint which is probably of no current clinical significance. Mild osteoarthritis affects the tibiotalar joint. There is generalized atrophy of the musculature of the foot and ankle. There are multiple foci of signal void extending from the medial aspect of the calcaneal tuberosity to the midfoot and proximal forefoot along the quadratus plantae muscle and flexor digitorum longus tendon which were not present on the prior study and are of uncertain etiology, but we cannot exclude the possibility of gas extending from the ulceration to the midfoot/forefoot. There is diffuse subcutaneous edema.
1. Osteomyelitis of the posterior tuberosity of the calcaneus as described above with an associated mildly displaced avulsion fracture of the superior aspect of the posterior calcaneal tuberosity.2. Foci of signal void extending from the medial aspect of the posterior tuberosity of the calcaneus into the plantar soft tissues of the midfoot and forefoot along the quadratus plantar muscle and flexor digitorum tendon which may represent soft tissue gas. This could be further evaluated with repeat radiographs.