Diabetic foot infection - necrotizing cellulitis and deep soft tissue infection with osteomyelitis
Presentation
Diabetic foot ulcer.
Patient Data
Indurated soft tissue at the lateral aspect of the forefoot centered on the metatarsophalangeal joints, with a large section of nonenhancement on the plantar forefoot extending from the lateral skin edge to the 3rd webspace mediolaterally and proximally to at least the base of the 5th metatarsal. Non-enhancement of abductor digiti minimi, flexor digiti minimi, lateral aspect, flexor digitorum brevis, and the lateral lumbricals and interossei muscles.
Destruction of the 5th metatarsal head, 5th proximal phalanx, and the proximal portion of the 5th middle phalanx. Marrow enhancement extending to the proximal 5th metatarsal shaft.
Destruction of the 4th metatarsophalangeal joint extending into the 4th metacarpal neck and the 4th proximal phalanx.
Bone marrow edema at the lateral aspect of the 3rd metacarpal head and the 3rd proximal phalangeal base with corresponding low T1 signal.
Case Discussion
Extensive lateral forefoot infection including necrotizing cellulitis and necrotizing deep soft tissue infection along with osteomyelitis of the 3rd-5th rays with septic arthritis of the 4th and 5th metatarsophalangeal joints.
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