Osteomyelitis of the head of the first metatarsal bone

Case contributed by Dr Bruno Di Muzio


Erythema, pain, and swelling on the left hallux.

Patient Data

Age: 77-year-old
Gender: Female

Forefoot radiographs

Hallux valgus and claw toes deformity. Soft tissue swelling over the medial aspect of the first metatarsophalangeal joint. No bony erosions or soft tissue calcification to suggest gout. No definitive evidences od osteomyelitis. 

Marrow edema and patchy subcortical enhancement at the dorsomedial aspect of the head of the first metatarsal bone. Subcutaneous enhancement and edema overlying this region. No evidence of subcutaneous collections to suggest abscess. There is a moderate 1st MTP joint effusion. No sesamoid edema or enhancement. Hallux valgus deformity. Bone marrow and joint spaces are otherwise unremarkable. No evidence of fractures. 

Case Discussion

MRI was consistent with early changes of osteomyelitis of the head of the first metatarsal bone.

Aspiration was performed: 

Specimen Type : Synovial Fluid

CRYSTAL EXAMINATION (POLARIZATION MICROSCOPY): Sodium Urate Crystals NOT Detected Calcium Pyrophosphate Crystals NOT Detected

GRAM STAIN Leukocytes +++ Epithelial Cells + Gram-positive cocci +

CULTURE 1. Staphylococcus aureus +++

SENSITIVITIES 1 Clindamycin S Cotrimoxazole S Erythromycin S Fusidic Acid S Oxacillin S Penicillin R Rifampin S Vancomycin S


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Case information

rID: 48372
Published: 29th Oct 2016
Last edited: 16th Jul 2018
Tag: rmh
Inclusion in quiz mode: Included

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