79-year-old female with pain and swelling. Evaluate for osteomyelitis. Severe osteoarthritis affects the first MTP joint and mild osteoarthritis affects the interphalangeal joints.There is edema type signal seen within the middle phalanx of the third toe on T2 fat suppressed images, although the marrow maintains a normal fatty signal on T1 weighted images. The constellation of findings suggests reactive osteitis, with acute osteomyelitis considered less likely. There is mild edema along the dorsum of the foot as well as atrophy of the foot musculature. We see no discrete fluid collections.
1.Edema-type signal within the middle phalanx of the third toe is thought to represent reactive osteitis as opposed to osteomyelitis. This can be followed with dedicated toe radiographs if clinically warranted.2.Osteoarthritis and other findings as above.