Acute pyogenic osteomyelitis of the metatarsal


Acute pyogenic osteomyelitis within the first 48 hours may show subtle soft tissue swelling, loss of fat planes or air within the tissue track from the penetrating injury but most often radiograph is entirely normal. At 1 week the earliest radiograph feature is intramedullary trabeculae destruction. This is followed by enosteal scalloping, cortical destruction and periostitis which is only apparent after 2 weeks. Chronic osteomyelitis is typified by periosteal new bone formation, sequestrum/involucrum which maybe seen from 6 week onwards.