This interesting case highlights the clinical progression of a rare disease process and the important role of a multi-disciplinary team in achieving a diagnosis and successful management plan.

Case Presentation

A 76-year-old male with a history of coronary artery disease, hypertension and hyperlipidemia presented as an outpatient with left foot pain and swelling. He had spent a week bicycling in Colorado one month prior to presentation. The pain was initially localized to the plantar surface of his foot and progressed to involve the lateral and dorsal aspects of the foot, as well as his great toe. The pain was accompanied by swelling of the midfoot without erythema and he was unable to bear weight. His podiatrist prescribed Ibuprofen and a foot brace for empiric treatment of tendonitis. An outpatient MRI demonstrated extensive bony edema and synovial enhancement within the midfoot, as well as severe superficial edema and peroneal tendonitis with mild subluxation. The patient was sent to the emergency department to be evaluated for osteomyelitis.