AMA Radiology

79 year old with fever and unable to stand on foot.

Radiograph of the foot in an adult patient’ there is an abnormal appearance of the fifth metatarsal with fragmentation, disorganisation and degenerative change involving the joint.  No localised collections.  Potential changes involving the fourth metatarsal head. No vascular calcification is appreciated.  Degenerative changes present within the tarsal bones.  The radiological appearance raises concern for a osteomyelitis.  If this was in my outpatient reporting pile I would urgently fax report to the referring physician and suggest orthopaedic review and MRI scan to delineate the extent of involvement further.