A, B: DP and oblique radiographs of the right foot show increased sclerosis of the distal phalanx of the great toe. Small erosions are present at the base.

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A, B: DP and oblique radiographs of the right foot show increased sclerosis of the distal phalanx of the great toe. Small erosions are present at the base of the distal phalanx and there is some hypertrophic change as well. There is some regional soft tissue edema as well. This is a young patient who fell off a tree a few weeks earlier, broke his great toe nail, and presented to the ED with a red, swollen, and painful toe. The radiographic findings are consistent with chronic osteomyelitis. Reactive arthritis and psoriatic arthritis are in the differential and can produce an identical radiographic appearance of the distal phalanx of the great toe but the clinical information fits chronic osteomyelitis better. C-F: Sagital T1, FS T2, Fs T1, and Gd-enhanced FS T1-weighted images of the great toe show subtle replacement of the normal T1 hyperintense marrow signal with T1 isointense signal, as well as marrow edema and mild enhancement. There is mild surrounding soft tissue edema and enhancement. There is no joint effusion. There are no abscesses. There is no unenhancing (devitalized) bone. Source: Chapter 10. Lower Extremity, The Atlas of Emergency Radiology Citation: Block J, Jordanov MI, Stack LB, Thurman R. The Atlas of Emergency Radiology; 2013 Available at: http://accessemergencymedicine.mhmedical.com/DownloadImage.aspx?image=/data/books/bloc1/bloc1_c010f116c.png&sec=42499707&BookID=573&ChapterSecID=42496372&imagename= Accessed: October 19, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved