Presentation
Diabetic and chronic right foot pain and swelling with an ulcer at plantar aspect.
Patient Data
Extensive bone marrow signal changes (T1 hypointense, T2 and PD hyperintense) is seen involving the big and 2nd toes phalanges as well as 4th toe proximal phalanx compatible with osteomyelitis.
Sinus tracts are seen from the 1st and 2nd metatarsals as well as big toe proximal phalanx head into the skin in the plantar aspect.
Abnormal bone marrow signal (Iso on T1 and high on PD fs) also is seen at the metatarsals, medial sesamoid and the other phalanges of the 3rd to 5th toes due to osteitis.
Extensive edema and fluid signal intensity also are seen within the forefoot and midfoot intrinsic muscles and subcutaneous tissues.
Case Discussion
Diabetes mellitus can involve the foot by two mechanisms:
First one is osteomyelitis which mainly affects the pressure points in the forefoot and hindfoot.
The second one is a neuropathic joint which affects the intertarsal joints causing joint destruction, disorganization and dislocation.
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