Radiological investigations

With all the above presentations of infection, it is important to X-ray the foot to detect

• Signs of osteomyelitis

• Gas in the deep tissues

• Radio-opaque foreign body.

In the initial stages of osteomyelitis, X-ray may be normal. Signs of osteomyelitis such as localized loss of bone density or cortical outline may not be apparent for at least 14 days.

Magnetic resonance imaging (MRI) may be useful to look for the presence of osteomyelitis and also to detect collections of fluid in the foot. Intravenous injection of gadolinium-containing contrast agent heightens the sensitivity of the diagnosis of these clinical features. The sequences employed in MRI for detection of soft tissue and bony abnormalities include Tl, short tau inversion recovery (STIR) and postgadolinium with fat suppression.

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