60-year-old male with a left foot diabetic ulcer. Evaluate for osteomyelitis in the left foot. There are extensive arthritic changes of the midfoot as seen on recent radiographs, likely reflecting neuropathic arthropathy. There is fragmentation of the navicular with multiple ossicles situated dorsal to the head and neck of the talus. There are multiple subchondral cysts within the head and neck of the talus with an additional ossicle noted inferior to the head of the talus perhaps also arising from the fragmented navicular bone. The head of the talus now articulates with the cuneiform bones with moderate to severe degenerative arthritic changes affecting the remainder of the midfoot. There is partial ankylosis of the middle and medial cuneiforms. Moderate osteoarthritis affects the calcaneocuboid joint and ankle joint. We see no marrow edema, however, to suggest osteomyelitis. There is subcutaneous edema involving the ankle, particularly along the medial aspect of the ankle. There is mild distortion of the ankle ligaments due to neuropathic arthropathy, but we see no frank tear. The tendons of the ankle likewise appear intact. There is plantar flexion of the talus with loss of much of the sinus tarsus fat likely representing a combination of synovitis and scarring. There is atrophy of the musculature of the foot and ankle.
Neuropathic arthropathy of the midfoot and other findings as described above without evidence of osteomyelitis.