Presentation
Great toe ulcer.
Patient Data
Prior amputation of the 2nd digit through the MTP joint. Marked soft tissue swelling of the hallux, with diffuse irregular loss of medullary and cortical bone of the distal phalanx, in keeping with advanced osteomyelitis. The 1st interphalangeal joint is narrowed and there are some erosions, both medially and laterally of the proximal phalangeal head, suggesting intra-articular involvement (septic arthritis). Gas lucency is seen within the soft tissues, raising the suspicion of gas-forming organisms. The dorsal soft tissues of the foot are grossly swollen. Vascular calcification noted.
Case Discussion
The toe was amputated through the distal shaft of the proximal phalanx. Surgical notes indicate the distal phalanx was necrotic.
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