Foot and ankle swelling There is diffuse subcutaneous edema of the foot particularly along the dorsal aspect of the metatarsals. Overlying the base of the third through fifth metatarsals is lobulated, ill-defined collection of fluid signal intensity. Following contrast administration, there is irregular peripheral enhancement of this collection. There are small areas of low signal intensity within the collection which could represent foci of gas. Additional small collections are noted between bases of the second and third metatarsals (ankle MRI series 10 image 33/42) as well as in the region of the sinus tarsi (ankle MRI series 10 image 28/42). There are erosions of the midfoot and tarsometatarsal articulation particularly involving the base of the first, third, and fourth metatarsals. Additionally, there is erosion of the head of the first metatarsal with a large associated soft tissue component. There are scattered areas of increased T2 marrow signal particularly in the bases of the metatarsalshowever there is no corresponding low signal on T1 to suggest osteomyelitis. There is no abnormal joint fluid within the foot.The visualized extensor tendons are intact. The visualized flexor tendons are intact. The peroneal tendons are intact. There is no subluxation or dislocation in the tarsometatarsal articulationsThere is normal alignment of the metatarsals.
1. Findings concerning for early abscess within the dorsal and lateral soft tissues of the foot. Additional small collections and phlegmonous changes are noted in the plantar soft tissues of the midfoot and near the sinus tarsi detailed above. There is no evidence of osteomyelitis.2. Changes of gouty arthropathy similar to the prior exam.