Case contributed by Wael Nemattalla


Known diabetes, complains of right foot pain.

Patient Data

Age: Elderly
Gender: Male

Evidence of destruction of the 5th metatarsal head, cortical disruption and periosteal reaction. Further area of cortical bone loss and focal osteopenia with the 5th proximal phalanx base. No obvious soft-tissue defect is identified.  Findings in keeping with osteomyelitis/ septic arthritis.

Follow up radiograph


The cortical loss and focal osteopenia within the 5th proximal phalanx base is more prominent.  Redemonstration of the 5th metatarsal head destruction with a larger amount of periosteal reaction extending along the 5th metatarsal proximally. Findings in keeping with ongoing osteomyelitis.  

Case Discussion

The key findings in osteomyelitis are focal osteopenia, cortical destruction, and periosteal reaction.  Ulceration of the soft tissues will not always apparent on radiographs but should be a review area.  

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