Osteomyelitis in diabetic foot

Case contributed by Bahman Rasuli


Diabetic and chronic right foot pain and swelling with an ulcer at the dorsal aspect.

Patient Data

Age: 70 years
Gender: Male
  • extensive bone marrow signal changes (T1 hypointense, T2, and PD hyperintense) involving the 3rd metatarsal head and neck and proximal phalanx base and shaft compatible with osteomyelitis
  • mild effusion at the 3rd metatarsophalangeal joint

  • sinus tract starts from the level of the 3rd metatarsophalangeal joint into the skin in the dorsal aspect
  • amputation of 2nd digit
  • abnormal bone marrow signal (low on T1 and high on T2/PD fs) also is seen at the 2nd metatarsal mid to distal diaphysis due to osteomyelitis
  • extensive edema and fluid signal intensity in intrinsic muscles and subcutaneous tissues of the forefoot and midfoot
  • degenerative changes at first metatarsophalangeal joint 

Case Discussion

Diabetes mellitus can involve the foot by two mechanisms:

  • firstly, osteomyelitis which mainly affects the pressure points in the forefoot and hindfoot
  • secondly, neuropathic joint which affects the intertarsal joints causing joint destruction, disorganization, and dislocation

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