FIRST TOE - Suppurative arthritis and cellulitis

The specimen consists of the terminal phalanx and approximately half the proximal phalanx of the first toe. Over the ball of the toe there is large callosity some 2.5 cm in length. The underlying tissues are grossly oedematous; the interphalangeal joint appears intact but the outline of the terminal phalanx is indistinct.
Four years before, this woman who was overweight, suffered a fractured pelvis and fractured femur in a car accident. Gait subsequently was awkward and she developed a number of callosities on her feet. Infection developed under one of these on her great toe leading to cellulitis, to involve the joint and demineralisation of the bone. The response to antibiotics was poor and the toe was amputated.