Female 65 years old. Reason: evaluate for osteo. History: Charcot foot, diabetes There is an ulcer of the soft tissue along the plantar aspect of the midfoot, with a collection of heterogeneous (partially fluid) signal intensity extending dorsally from the ulcer between the anterior aspect of the remaining calcaneus and the base of the fourth and fifth metatarsals up to the ankle joint. Overall, the collection is approximately 9 cm in greatest diameter. It surrounds what is left of the talus and abuts the tibial plafond. It also abuts the navicular and extends posteriorly along the lateral margin of the remaining calcaneus as well as to the distal fibula laterally and the medial tendons medially. There is abnormal signal intensity (low on T1 weighted images and high on T2 weighted images) involving the anterior and lateral aspect of the calcaneus, remainder of the talus, distal tibia, distal fibula, the navicular and lateral cuneiform, highly suspicious for osteomyelitis. The medial malleolus is completely eroded. The head and neck of the talus are absent and the cuboid is not clearly visualized on this study presumably secondary to long-standing erosion. There is also relatively mild signal abnormality and erosion of the remaining cuneiforms and the metatarsal bases suggesting long-standing neuropathic arthropathy, although additional foci of osteomyelitis cannot entirely be excluded.The posterior tibial tendon is abnormally thickened and of abnormal signal intensity likely reflecting tendinosis and type I tearing. Fluid signal intensity along the posterior tibial tendon and the flexor digitorum longus likely reflects focal tenosynovitis. The peroneus longus tendon is enlarged with a split tear posterior to the fibula. The Achilles' tendon is slightly thickened indicating mild tendinosis. The anterior tendons are partially surrounded by the aforementioned fluid collection. The muscles of the ankle and foot are of increased signal intensity on T2 weighted images suggesting edema. There is also reticulation of the subcutaneous fat indicating subcutaneous edema.
Findings compatible with severe Charcot arthropathy. There is also a plantar soft tissue ulcer with heterogeneous fluid tracking from the ulcer through the hindfoot/midfoot to the ankle joint, associated with bone destruction and signal abnormality as described above and consistent with extensive superimposed osteomyelitis. Other soft tissue findings as described above.