Presentation
Type 2 diabetic for 15 years ago referred with great toe ulcer.
Patient Data
Amputation of second digit distal to proximal phalanx base.
Extensive bone marrow signal changes (T1 hypointense, T2/PD hyperintense) are seen involving the great toe distal phalanx and proximal phalanx head and neck regions.
A sinus tract is seen from the great toe distal phalanx base to the skin along the distal lateral surface.
Tear of flexor hallucis longus tendon from its insertion (base of great toe distal phalanx) with retraction of proximal fibers is seen.
Edema and fluid signal intensity within the great toe subcutaneous tissues, forefoot and midfoot intrinsic muscles, and subcutaneous tissues at dorsal and medial aspects are seen.
Minimal joint effusion is seen at the first metatarsophalangeal joint.
Case Discussion
Based on the above imaging findings, great toe osteomyelitis is the main diagnosis.