Patient History
53 F with cellulitis and pain of right toes
Findings
ARTICULATIONS:
Bone: Nondisplaced pathologic microtrabecular fracture of the entire great toe distal phalanx, diffuse osteoedema, periostitis and surrounding soft tissue swelling.
Forefoot: Chronic fragmentation of the sesamoid likely reflecting avascular necrosis or sequela of prior sesamoiditis.
LIGAMENTS:
Collateral Ligaments: Intact.
TENDONS:
Flexor Compartment: Intact.
Extensor Compartment: Intact.
Plantar Plate: Attenuation of the central aspects of the 2nd and 3rd plantar plates.
GENERAL:
Muscles: No traumatic muscle injury. No volumetric muscle atrophy.
Soft Tissue: Focal penetrating soft tissue injury at the dorsal lateral aspect of the great toe tuft, adjacent to the toenail.
Hypertrophic plantar callus underlying the 1st and 5th MTP joints.
Joint Effusion: Normal capsulitis of the 1st MTP joint.
Intra-Articular/Loose Bodies: None.
Impressions
1. Focal penetrating injury at the dorsal lateral aspect of the great toe tuft adjacent to the toenail.
2. Great toe tuft osteomyelitis with distal phalangeal osteitis resulting in a pathologic, nondisplaced, extra-articular microtrabecular fracture with periostitis and surrounding soft tissue swelling.
3. Chronic fragmentation of the sesamoid likely reflecting avascular necrosis or sequela of prior sesamoiditis.
