PMC10403705_01
Pictures demonstrating the gross appearance of the right foot of the patient (A and B). There was diffuse swelling and multiple nodularities, as well as dry sinus tracts.
gr1.jpg
PMC10403705_01_gr1.jpg
fig0005
On physical examination at presentation, he had a large, nodular, nontender mass on the dorsal aspect of the right foot with multiple sinus tracts that were not draining fluid (Fig. 1).
Frontal (A) and oblique (B) radiographs of the right ankle and foot of the patient show soft tissue swelling and erosion on the 1st proximal phalanx medial cortex giving a half-moon appearance with adjacent solid periosteal reaction.
gr2.jpg
PMC10403705_01_gr2.jpg
fig0010
A right ankle US shows multiple lesions (arrows) with thick hypoechoic walls and hyperechoic foci in the center giving the appearance of a ''dot in a circle'' (A) suggestive of a Madura foot. There is cortical irregularity over the right 1st metatarsus and proximal phalanx (B and C). A color Doppler examination (D) shows hypervascularity of the surrounding soft tissue.
gr3.jpg
PMC10403705_01_gr3.jpg
fig0015
Further examination of the patient with US of the right ankle and foot revealed a lesion with a heterogeneous echo pattern on the dorsum of the right foot, containing multiple hypoechoic thick-walled lesions with small sharp hyperechoic foci (dot-in-circle sign) (Fig. 3).
PMC10403705_02
Anteroposterior (A) and lateral (B) radiographs of the right foot and ankle show lytic lesions involving the navicular and cunifom bones as well as the metatarsal bases.
gr4.jpg
PMC10403705_02_gr4.jpg
fig0020
A plain radiograph showed lytic lesions involving the navicular and cunifom bones as well as the metatarsal bases. (Fig. 4).
A T1-weighted coronal MRI scan of the right ankle (A) shows multiple hypointense nodules of various sizes, diffusely affecting subcutaneous tissue, muscle, and bone. The lesions are hyperintense, with a central and peripheral border of hypointensity on the PDW SPAIR sagittal section (B). T1W sagittal sections pre (C) and post (D) contrast administration show contrast enhancement of the lesion with the "dot-in-circle" sign.
gr5.jpg
PMC10403705_02_gr5.jpg
fig0025
T2 and PDW SPAIR, and showed contrast enhancement (Fig. 5). There were also diffuse marrow changes of the hind, mid, and forefoot bones, except the calcaneous and cuboid.