Acute pyogenic osteomyelitis of the metatarsal

Case contributed by Dr Charlie Chia-Tsong Hsu


Stepped on a thorn. Penetrating injury to plantar surface of left foot.

Patient Data

Age: 40
Gender: Male

Initial radiograph 3 days after the inciting event is unremarkable. 


repeated at 14 days

Erosion of the intramedullary trabeculae and cortical destruction of the head of the 4th metatarsal. 

Nuclear medicine

Technetium 99m HDP (bone scan)

Blood flow and blood pool images show increased radiotracer distribution in the left distal foot, likely localizing to the distal aspect of the 4th metatarsal.

Case Discussion

Acute pyogenic osteomyelitis within the first 48 hours may show subtle soft tissue swelling, loss of fat planes or air within the tissue track from the penetrating injury but most often radiograph is entirely normal. At 1 week the earliest radiograph feature is intramedullary trabeculae destruction. This is followed by enosteal scalloping, cortical destruction and periostitis which is only apparent after 2 weeks. Chronic osteomyelitis is typified by periosteal new bone formation, sequestrum/involucrum which maybe seen from 6 week onwards. 

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Case information

rID: 26225
Published: 7th Dec 2013
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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