75M Diabetic with Chronic Plantar midfoot ulcer.
Podiatrist saw the MT cortical thickening and referred for MRI to rule out
osteomyelitis.
Marrow signal is normal and the plantar ulcer is superficial.
There is chronic / acute on chronic denervation muscle atrophy and edema.
What is the etiology of the 2nd-4th metatarsal cortical hyperostosis?
I gave a DDx of thyroid acropachy and hypertrophic osteoarthropathy…but I
would not expect those to be selective (sparing the 1st and 5th or
phalanges), so I don’t really believe it.
What do you suggest?
[image: 1.jpg]
[image: 2.jpg]
[image: 3.jpg]
[image: 4.jpg]
[image: 5.jpg]
I received several responses which varied dramatically.
Nobody thought that it looks like HPO or Thyroid acropachy.
Joe Craig said “normal variant”.
Kyung Jin Suh attached an image from Keats that shows much less florid
cortical thickening at the proximal MTs…though the Keats example seems
quite different from this in my opinion.
Iwona Sudol-Szopinska wrote: There are some papers relating that periosteal
thickening of MET with DM but it is non specific and seen in normal
individuals. We don’t even report it.
Aline Serfaty shared an article citing MT periosteal thickening as a common
non-specific finding in the diabetic foot.
I will amend my report and contact the podiatrist and say NEVER MIND.
Thank you all.
Hilary
[gallery]