Presentation
Diabetic and chronic right foot pain and swelling with an ulcer at the dorsal aspect.
Patient Data
Age: 70 years
Gender: Male
From the case:
Osteomyelitis in diabetic foot
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- 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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