Reason: h/o L first metatarsal fracture, concern for osteomyelitis History: pain, swelling, purulent drainage There is nonenhancing fluid signal intensity which extends from the tip of the great toe to the tuft of the distal phalanx likely representing ulceration or sinus tract formation. The distal phalanx is replaced with abnormal signal intensity and enhancement likely due to both osteomyelitis and edema from the pathologic fracture as seen on recent radiographs. The fracture itself is better seen on prior radiographs. There is edema and enhancement of the surrounding soft tissues of the first toe indicating inflammation. We see no evidence of osteomyelitis of the proximal phalanx of the great toe or of the first metatarsal. We see no first metatarsal fracture. Mild osteoarthritis affects the midfoot. There is fatty atrophy of the musculature of the foot. There is a small amount of fluid within the flexor hallucis longus tendon sheath, proximal to the sesamoids, which may represent a mild tenosynovitis but this is of questionable current clinical significance.
Osteomyelitis of the distal phalanx of the great toe and pathologic fracture. These findings were relayed to Dr. Demagio via phone at 11:38 AM on 12/11/2015.