Osteomyelitis of the 5th metatarsal head
2 months of 5th toe pain. Diabetic.
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Focal bone loss of the plantar aspect of the head of the 5th metatarsal. The 5th MTP joint appears intact. Extensive vascular calcification. Features in keeping with osteomyelitis. The adjacent soft tissues are thickened and there is a overlying dressing suggesting an ulcer as the cause.
X-ray findings of osteomyelitis are usually only evident after 7-10 days.
The patient went on to have an amputation after failing medical therapy, and histology and MCS confirmed S. aureus osteomyelitis.