Presentation
A diabetic patient presented with a skin ulcer on the hindfoot and elevated inflammatory markers.
Patient Data
There is a skin defect observed in the hindfoot at the plantar aspect of the posterior calcaneus (heel) with an underlying restricted diffusion collection, measuring about 1.9 x 1.5 cm. This suggests an abscess without an obvious sinus tract tracking toward the calcaneal bone.
However, a small focal area of bone marrow oedema is observed in the inferior posterior aspect of the calcaneal bone, with no definite cortical destruction or bony defect.
Diffuse subcutaneous oedema is more obvious in the dorsal aspect, as well as intermetatarsal oedema.
Muscular oedema is noted in the flexor digitorum previous and quadratus plantae muscle.
No joint deformity, subluxation, or dislocation is evident.
Case Discussion
A combination of metabolic dysfunction, neuropathy, immunopathy, and peripheral vascular disease contributes to the development of the diabetic foot.
Neuroarthropathy can manifest in acute or chronic stages. In the acute stage, there is oedema and warmth that may mimic cellulitis. As the disease progresses, joint fragmentation, destruction, or subluxation may develop.
Abscess formation is a complication of diabetic foot, appearing as localised collections of pus within a confined space that become walled off by vascularised connective tissues over time.
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