Reason: Evaluate for osteomyelitis in L foot. History: L foot ulceration There is ulceration of the plantar soft tissues beneath the first MTP joint. The ulceration extends to the flexor hallucis longus tendon and there is trace fluid and enhancement surrounding the tendon as it courses beneath the first metatarsal head. There is also edema and enhancement of the adjacent soft tissues extending into the great toe consistent with cellulitis. There is mild enhancement of the skin of the dorsum of the foot and edema in the underlying subcutaneous fat which may reflect additional relatively mild cellulitis. There is also edema within the plantar musculature of the foot but we see no focal fluid collection to suggest abscess. There is abnormal signal intensity within the medial sesamoid bone beneath the first metatarsal head (low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging) compatible with osteomyelitis. There is similar but slightly less pronounced signal abnormality noted within the lateral sesamoid bone, which is also concerning for osteomyelitis. There is enhancement of the first MTP joint indicating synovitis which is nonspecific and could be degenerative or inflammatory/infectious in etiology. There is minimal fluid within the first MTP joint. On the fluid sensitive sequences, there is patchy subchondral increased signal intensity within the head of the first metatarsal and base of the proximal phalanx which enhances following gadolinium administration. On the T1-weighted images, there is low signal intensity involving the first metatarsal head concerning for early osteomyelitis. Marrow signal intensity in the proximal phalanx is relatively preserved on the T1-weighted images, suggesting that the abnormal signal intensity on the fluid sensitive sequences in this area may reflect reactive osteitis rather than osteomyelitis. The marrow of the distal phalanx of the great toes is normal. The remaining bone marrow signal intensity is within normal limits.
Plantar soft tissue ulcer with osteomyelitis of the sesamoid bones and possibly the first metatarsal head as well.Findings discussed with Dr. Harter at the time of dictation.