Osteomyelitis - 4th and 5th toes

Case contributed by Bahman Rasuli


Type 2 diabetic for 10 years, referred with forth webspace ulcer at dorsal aspect.

Patient Data

Age: 50 years
Gender: Male

Osteolysis and destruction of the 5th toe proximal phalanx head and middle phalanx

Sclerotic changes at the 4th toe proximal phalanx

Flattening of the 2nd metatarsal head with subchondral sclerosis associated with the secondary degenerative changes in keeping with Freiberg disease.

Dorsalis pedis artery calcification is seen.

Abnormal bone marrow signal (low on T1 and high on PDFS) involving the fifth toe phalanges and fourth toe proximal phalanx associated with skin ulcer at the fourth web space at the dorsal aspect related to osteomyelitis.

The second metatarsal head shows flattening, cortical irregularity, patchy marrow edema and secondary degenerative changes due to Freiberg disease.

Case Discussion

Regarding the above imaging findings, 4th and 5th toes osteomyelitis and second metatarsal head Freiberg infarction, which appears chronic with secondary degenerative change, are the main imaging findings.

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