61-year-old male patient with left foot wound and elevated CRP/ESR. Evaluate for osteomyelitis. The first toe is amputated through the metatarsophalangeal joint. The second and third toes are amputated through the proximal phalanges. There are foci of signal void in the soft tissues at the amputation sites, which may be postsurgical in etiology.There is thickening of the skin along the undersurface of the head of the second metatarsal with replacement of subcutaneous fat with intermediate signal intensity, likely representing a combination of granulation tissue and edema. There is also focal irregularity of the plantar skin surface more proximally with underlying signal abnormality. These skin abnormalities may represent sites of ulceration. There is a flattening of the second metatarsal head with abnormal low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging as well as mild enhancement following gadolinium administration. While we cannot exclude osteomyelitis (likely chronic given the radiographic appearance), this could represent sequelae of chronic mechanical trauma, similar to that seen in Freiberg's infraction as described in the prior radiograph report, as we see no sinus tract leading to the bone. There is also abnormal signal intensity in the second metatarsal diaphysis more proximally. While this is nonspecific, we suspect this is degenerative in etiology as there are osteoarthritic changes in the tarsometatarsal joints that have progressed compared to prior MRI. This finding raise the possibility of early neuropathic arthropathy. We see no evidence of osteomyelitis in the remaining metatarsals, phalanges, or sesamoid bones. There is atrophy of the musculature of the foot and edema type signal within the musculature on fluid sensitive sequences, which is not uncommon in diabetic patients. There are no fluid collections to suggest abscess.
Abnormal signal intensity and flattening of the second metatarsal head as described above. While we cannot exclude osteomyelitis (likely chronic given the radiographic appearance), these findings could represent sequelae of chronic mechanical trauma, similar to that seen in Freiberg's infraction, as we see no sinus tract leading to the bone.