Bone Infection And Osteomyelitis In Diabetes Patient - Foot X-ray And MRI

This video presents the radiograph and MR imaging of foot in a diabetic patient with poor sugar control.

Clinical information. 45-year-old diabetic patient in renal failure. Reportedly picking on plantar callus at the level of the metatarsal head of the 2nd or 3rd right toe. This was later infected and draining pus with staphylococcus infection. Later there was diffuse swelling of the right forefoot, especially in the dorsal aspect and lateral aspect of the right foot. There is clinical concern for osteomyelitis.

Findings. There is significant progression of extensive arteriovascular calcification of the right foot. There is increased atrophy of the subcutaneous tissue since prior study. Previous subcutaneous tissue thickness measured approximately 9.2 mm at the level of the proximal phalanx of the great toe. It currently measures approximately 7 mm.

The joint space of the navicular-middle cuneiform articulation also becomes slightly irregular, new since prior study.

A skin marker was placed over the area of skin defect in the dorsal aspect of the right forefoot. There is approximately 3.5 x 2.7 cm skin defect over the 4th and 5th metatarsophalangeal joint region. There is extensive adjacent cellulitis, most prominently seen inferior and lateral to the 5th metatarsophalangeal joint region. No focal fluid collection to suggest abscess.

There is marrow signal abnormality of the middle phalanx, proximal phalanx and head of the metatarsal bone of the 5th toe, consistent with osteomyelitis. No bony erosion visualized. There is moderate 5th metatarsophalangeal joint effusion suggestive of septic arthritis.

Incidentally noted is degenerative changes of the talonavicular joint, navicular-middle cuneiform articulation and middle cuneiform-2nd metatarsal articulation. I suspect this may represent early development of Charcot's joint.

There is extensive soft tissue edema of the intrinsic musculature of the foot and dorsum of the right foot, suggestive of cellulitis.

The extensor tendons, flexor tendons and plantar fascia are grossly unremarkable.