Presentation
The patient presents with acute, right foot swelling and pain. Negative trauma. Diabetic on history.
Patient Data
Radiographs confirm septic arthritis of the right 2nd digit, DIP joint, with bone erosion, destruction and significant asymmetric, soft tissue swelling of this toe. There are gaseous lucencies within the mid and hindfoot including distal calf soft tissues consistent with cellulitis/ gas gangrene.
Zoomed images demonstrate septic arthritis of the 2nd digit, DIP articulation. The reverse images assist in confirming a degenerate but otherwise intact right 2nd PIP joint. There is severe bony osteopenia inappropriate for age. There is degeneration of the 2nd MTP and 3rd DIP joints with subchondral cysts and bone erosions, gout is not excluded here.
There is a soft tissue bunion and bunionette.
The gaseous locules/gas gangrene is well visualized in the contrast-adjusted and zoomed ankle and distal calf images
Case Discussion
Features consistent with septic arthritis and gas gangrene in a diabetic patient. Surgical amputation of the right second digit was planned to control the source of sepsis.