Osteomyelitis of the Distal Phalanx on Plain Films

This patient demonstrates soft tissue swelling and bone destruction of the distal phalanx of the great toe due to osteomyelitis. There is unrelated flattening and sclerosis of the second and third metatarsal heads due to healed avascular necrosis (AVN).

Discussion
This patient was on systemic steroids, which predisposes to both osteomyelitis and AVN. Osteomyelitis may first present with soft tissue swelling with or without radiolucent gas collections. Later, lytic destruction of the underlying bone may occur. Common causative organisms include Clostridia, E. Coli, Streptococci, and Bacteroides. Osteomyelitis is more frequent in patients with arterial disease, diabetes, and patients on systemic steroids.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=59770175-977c-424c-96ae-95f16a81e1bb