Presentation
Diabetic and chronic left foot pain, warmth, and swelling with an ulcer at the plantar aspect.
Patient Data
extensive bone marrow signal changes (T1 hypointense, T2, and PD hyperintense) involving the 5th metatarsal and proximal phalanx compatible with osteomyelitis
mild effusion at the 5th metatarsophalangeal joint
sinus tract starts from the level of the 5th metatarsophalangeal joint into the skin in the plantar aspect
bone marrow oedema (T2, and PD hyperintense) along with cuboid bone, 3rd and 4th metatarsals head and neck consistent with osteitis
extensive oedema and fluid signal intensity in intrinsic muscles and subcutaneous tissues of the forefoot and midfoot
mild effusion at first metatarsophalangeal joint
Case Discussion
Imaging findings are consistent with 5th metatarsal and proximal phalanx osteomyelitis with interphalangeal joint septic arthritis.
Diabetes mellitus can involve the foot through two mechanisms:
osteomyelitis which mainly affects the pressure points in the forefoot and hindfoot
neuropathic joint affects the intertarsal joints causing joint destruction, disorganisation, and dislocation
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