Osteomyelitis of the calcaneum
Ulcer on heel of foot.
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Soft tissue defect noted at posterior calcaneus. Cortical erosion and bony destruction with a permeative pattern are seen at the posterior calcaneus. Remaining bones are diffusely osteopaenic. Changes at the second metatarsophalangeal joint are degenerative and may represent the sequelae of Frieberg's infraction.
Conclusion: Changes at the calcaneus are compatible with osteomyelitis.
We often get asked to assess for osteomyelitis in the feet of diabetic patients. When undirected, this search is often like finding the proverbial needle in the proverbial haystack, however, there are clues that can aid in a more targeted review.
Firstly, there may be an indication of the site of concern (ulcer or erythema) in the clinical notes written on the requisition form. Secondly, there may be other clues on the image. In this case, there is clearly a soft tissue defect at the posterior aspect of the heel, correlating with a site of ulceration. We can then direct our search to the underlying bone, which sure enough reveals the cortical erosion.
Another important consideration is a comparison with old images, as these patients are usually imaged on multiple occasions.