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