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Fig. 5.15 (a) MRIT1 sequence shows normal uptake in soft tissues under extensor hallucis longus tendon, (b) Increased uptake on STIR sequence, (c) A small collection of fluid under

Kings College Hospital NHS Trust

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the extensor hallucis longus tendon (post gadolinium), (d) Temperature chart showing resolution of fever.

He underwent surgical debridement and 20 mL of pus was drained from the foot. Postoperatively he needed haemodialysis but the swelling of the foot gradually improved, and the ulcer healed. His renal function improved and he came off dialysis.

Keypoints

• Deep infection with soft tissue involvement can be associated with severe systemic upset and in some cases with renal failure

• The decision to carry out surgical debridement of a dia betic foot is a difficult one. It is often made on clinical grounds alone. The main indications are an abscess or extensive sloughing of subcutaneous tissue • An MRI may be helpful in locating fluid collections.

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