Osteomyelitis - diabetic foot

Case contributed by Mostafa Elfeky
Diagnosis probable


Left foot pain and swelling.

Patient Data

Age: 55 years
Gender: Male

Soft tissue swelling around the second toe with rounded lucency on its plantar aspect.

Short distal phalanx of the big toe with no cortical erosions, sequel of previous surgical debridement.

The patient didn't follow the surgeon's instructions and goes upstairs a lot on foot. The foot became swollen with increased redness and pus discharge.

After three weeks


Increased soft tissue swelling related to the second toe with fracture head of second metatarsal and fracture base of the proximal phalanx of the second toe with metatarsophalangeal dislocation and multiple bone fragments. The fractured bone parts show decreased bone density and cortical erosions. The proximal part of the second metatarsal also shows diffuse osteopenia, cortical erosions and dense periosteal reaction.

Case Discussion

Features are suggestive of acute osteomyelitis secondary to diabetic foot infection complicated by metatarsal and phalangeal fractures. Radiographic features of osteomyelitis are focal osteopenia, cortical destruction, and periosteal reaction. Acute osteomyelitis may not appear on plain radiograph for 7-10 days.

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