Reason: Diabetic foot ulcer with ankle and foot pain and elevated ESR CRP History: pain Transmetatarsal amputation. Ulceration plantar to the base of the fifth metatarsal. Rim-enhancing fluid collections extend from the ulceration into the soft tissues along the lateral aspect of the base of the fifth metatarsal consistent with small, likely draining, abscess, some of them containing signal voids likely representing air. Overall collection of draining abscesses measures 4 cm in the largest dimension. Thickening and enhancement of the overlying skin and diffuse enhancement of the adjacent fat indicating cellulitis. Diffuse reticulation of subcutaneous fat of the foot indicating edema. Abnormal signal intensity and enhancement replacing much of the remaining base of the fifth metatarsal indicating osteomyelitis. Increased signal intensity seen on STIR sequences in the remaining metatarsal bases as well as bones of the midfoot suggestive of reactive osteitis rather than osteomyelitis, with relatively normal signal on T1-weighted sequences.
Postoperative changes of the transmetatarsal amputation with ulceration associated with draining abscess and osteomyelitis of the remaining fifth metatarsal base.