Presentation
Presented 2 months after stepping on pin. Swollen, red foot Patient is diabetic. 20 year history of foot injury with no treatment at the time
Patient Data
2nd metatarsal fracture with surrounding sclerosis.
There is a fracture dislocation of the proximal aspect of the second metatarsal with associated extensive callus formation. There is generalized bone marrow edema throughout the cuneiform, cuboid, navicular and metatarsal bones. There is patchy edema in the talus and to a lesser extent the calcaneus.
There is phlegmonous soft tissue swelling and edema throughout the midfoot. There is moderate to marked tenosynovitis of the anterior compartment tendons. I do not identify a discrete soft tissue abscess or a definite sinus tract from skin to bone.
There is a mild joint effusion at the first MTP joint but there is no subchondral edema on either side of the articulation.
Case Discussion
All of the features seen could be attributed to a neuropathic Charcot type deformity but it is difficult to exclude superimposed infection given the degree of bone marrow edema.
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