91-year-old female patient with gangrene, drainage. Question of osteomyelitis. A marker is placed along the lateral aspect of the hindfoot and toes. The exam is essentially nondiagnostic for evaluation of the phalanges due to motion artifact and susceptibility artifact from air in the soft tissues. Signal abnormality within the proximal phalanx of the great toe could represent osteomyelitis, but this is equivocal. Signal abnormality within the first metatarsal head is probably degenerative in etiology, although we cannot entirely exclude the possibility of osteomyelitis. Otherwise, signal intensity of the remaining metatarsals and bones of the midfoot are within normal limits on T1-weighted images arguing against osteomyelitis. Loss of soft tissue along the posterior and plantar aspects of the heel is noted. There is mild subcortical edema-type signal within the posterior tuberosity of the calcaneus on the T2WI, but signal intensity on T1-weighted images is relatively preserved arguing against osteomyelitis. We see no frank enhancement of the calcaneus. There is diffuse soft tissue edema involving the ankle which extends into the foot. We see no ankle joint effusion or rim-enhancing fluid collection to suggest an abscess
1. Limited study as described above, particularly with regards to the toes, the phalanges of which are not well visualized on this study. Signal abnormality within the proximal phalanx of the great toe may represent osteomyelitis, but this is equivocal.2. Soft tissue ulceration along the calcaneus with edema type signal is suggestive of reactive osteitis with preservation of T1-weighted signal arguing against osteomyelitis.