Advanced Imaging of the Diabetic Foot and Its Complications
Copyright © 1999 T. Learch, A. Gentili. All rights reserved.
Revised: November 16, 2004.

Septic arthritis in the diabetic foot usually arises from contiguous osteomyelitis spreading into the joint. Occasionally septic arthritis may arise from penetrating injury into the joint. Joint space narrowing and destruction ensues, accompanied by joint effusion. The septic joint fluid may communicate with adjacent structures such as tendon sheaths.

55-year-old man with long standing diabetes. He had ulcer formation of the posterior ankle and hindfoot, with markedly swollen ankle. Sagittal STIR image demonstrates ankle effusion and reactive bone marrow edema at the anterior and posterior aspects of the distal tibia, anterior and posterior talus, and superior calcaneus. These represent the "bare areas" of the ankle joint where protective articular cartilage ends. These areas are the first to show marrow signal change in inflammatory and/or infectious arthritis. (Click on the image to see a larger version)

AB

A. Sagittal STIR image of patient with septic tibio-talar joint. The joint fluid communicates with the flexor digitorum longus tendon, dissecting proximally to form an abscess in the muscle belly. B. Arthrogram performed after aspiration of joint demonstrates contrast in the tendon sheath as well in a sinus tract which dissects out medially. (Click on the images to see larger versions)

Advanced Imaging of the Diabetic Foot and Its Complications
Copyright © 1999 T. Learch, A. Gentili. All rights reserved.
Revised: April 29, 2006.