Nuclear medicine - 6 months after injury, persistent pain and skin changes.
Bone scan: blood flow
Bone scan: blood pool
Bone scan: delayed
SPECT: delayed
Tc-99m MDP limited bone scan with SPECT/CT.
Early images: mildly increased blood flow and blood pool to the left foot, with foci of more markedly increased blood pool in the hindfoot and medial midfoot.
Delayed images: markedly increased osteoblastic activity adjacent to the posterior subtalar joint, adjacent to the articulation between the medial and middle cuneiform bones, and adjacent to the 1st TMTJ.
Moderately increased osteoblastic activity adjacent to the 1st MTPJ, and mildly increased periarticular osteoblastic activity elsewhere in the left foot.
Conclusion: Findings are suggestive of reflex sympathetic dystrophy/complex regional pain syndrome of the left foot, with superimposed arthropathy involving the posterior subtalar, intercuneiform and first TMT joints.