Presentation
20-year history of diabetes mellitus. Left great toe swelling and erythema for 1 week.
Patient Data
There is a deep soft tissue ulcer along the distal tip of the great toe, with surrounding soft tissue edema and enhancement, involving the nail bed. An erosion is noted in the distal aspect of the first distal phalanx, with underlying bone marrow edema, loss of T1 marrow signal, and marrow enhancement, indicative of acute osteomyelitis given the provided clinical history.
Multifocal osteoarthritis is observed in the midfoot and forefoot, characterized by high-grade cartilage loss, subchondral reactive marrow changes, and small marginal osteophytes. This condition primarily affects the first metatarsophalangeal joint and hallux sesamoid metatarsal articulations, with additional advanced degenerative changes partially imaged in the tarsometatarsal joints. The Lisfranc ligament remains intact.
The plantar fascia is unaffected. Scarring is noted in the plantar soft tissue along the first and fifth metatarsal heads, indicative of chronic changes related to fractures.
Case Discussion
This represents a case of osteomyelitis.
The patient has a long-standing history of diabetes mellitus and hypertension.
A biopsy from the area was positive for pseudomonas aeruginosa, per infectious disease.
Management included levofloxacin and cefepime for five weeks.
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