Findings
A three-phase Tc-99m bone scintigram was performed and showed increased blood flow to the right great toe on flow images and increased activity in the right great toe, right lateral foot, left great toe, left lateral foot and left midfoot on delayed images (plantar, right medial, left lateral). Subsequent Gallium-67 imaging showed hyperintense uptake in the right great toe consistent with osteomyelitis (plantar, right medial). There was also less intense but increased uptake in the left midfoot. Plain radiographs of the right foot showed no radiographic evidence of osteomyelitis. Plain radiographs of the left foot showed bone destruction and fracture fragmentation of the left tarsal bones (arrow) consistent with a neuropathic joint (diabetic osteodystrophy).
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J. Anthony Parker, MD PhD, jap@nucmed.bih.harvard.edu