MRI Online
Library

View this list on the Library Page

ResidentsGroupsPricing
MRI Online
MRI Online
MRI Online
Library

View this list on the Library Page

19b - Answer: 42-year-old male patient presents with left lateral foot pain

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 42-year-old male diabetic patient presents with left lateral foot pain and open sore.

(QUIZ ANSWER) A FINDING IN THIS CASE: 

All of the above.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS

ALIGNMENT -There is exaggerated midfoot varus angulation secondary to lateral or valgus shift related to the still identified fractures at the proximal diametaphysis 2nd, 3rd and 4th metatarsals. Previous small 5th metatarsal head and neck fragment remnant has greater lateral angulation. 

Interval widening of the Lisfranc joint plus proximal subluxation/dislocation and bayonet deformity of the first MTT articulation. The 1st metatarsal head has now migrated proximally by two-third cuneiform shaft length with osseous remodeling/osteolysis since June.

SOFT TISSUES - There is significant diffuse subcutis edema surrounding the midfoot with an irregular curvilinear non-enhancing fluid collection measuring 14mm deep to the interspace between the middle and lateral cuneiforms.  Inflamed or infected joint space at the base of the first MT. See below.

MARROW - Diffuse bone marrow edema is seen throughout the proximal shaft of the 1st metatarsal, medial cuneiform, middle and lateral cuneiforms and scattered reactive edema within portions of the talus, cuboid, calcaneus and bases of the fractured metatarsals. 

CONCLUSION:

SOFT TISSUES ABSCESSES AS DESCRIBED BELOW. MASSIVE LISFRANC CHARCOT FOOT WITHOUT OSTEOMYELITIS.

1. Extensive midfoot progression of Charcot foot, worsening Lisfranc disruption and proximal bayonet deformity of the first MTT. Divergent Lisfranc subluxation/dislocation and innumerable fractures.

2. Two collections in the soft tissues with rim enhancement most consistent with abscesses. One lies proximal to the subluxed 1st metatarsal base and the second collection is in the deep 3rd or 4th layer of the plantar space, same image, both approximately 1.5cm. (Plantar arch abscess deep to the central cuneiforms in the midfoot extending along the course of the inflamed peroneus longus tendon sheath). 

3. Massive diabetic amyotrophy.

LESSON 2, TOPIC 57

Case Challenge: Foot & Ankle MRI Cases

Case Challenge

Browse other topics in...

Content reviewed: August 31, 2021

View CME activity information