43-year-old female with diabetic wound about the right great toe for 2 weeks. Please value for osteomyelitis. A moderately deep ulcer is visualized along the plantar aspect of the first MTP joint with significant amounts of associated soft tissue edema and inflammatory change. There is a tiny focus of gas that just underlies the soft tissue defect.There is abnormal enhancement, again compatible with soft tissue inflammation within the aforementioned soft tissues, specifically about the first MTP joint. However, no cortical destruction is visualized. There is slight signal abnormality and abnormal contrast enhancement of the medial sesamoid of the first digit, likely representing reactive edema/inflammation. No fluid collections are seen.The tendons of the foot are grossly intact. The second through fifth metatarsals are intact without evidence of osteomyelitis.
Ulcer about the first MTP joint with associated soft tissue edema and inflammatory change. There is mild signal abnormality and contrast enhancement of the medial sesamoid of the first digit. As such, early osteomyelitis of the sesamoid cannot be excluded.Follow-up or serial imaging may be warranted if clinically warranted