A man in his mid-30’s with a medical history significant for obesity and diabetes on an insulin pump presents to the hospital with 4 days of gradually worsening right foot pain and swelling. He denies any fever but has had intermittent chills and also feels a bit of generalized weakness. He denies any other complaints.
Vital Signs & Physical Exam:
Vital signs are normal except for a pulse of 118 and a BP of 104/51 mmHg. Physical exam is otherwise normal except for a red swollen foot.
Initial Diagnostic Testing:
CBC: normal except for WBC = 19
Chem-7: normal except for glucose 431, bicarb 19
Imaging: see plain film below
What is the most likely diagnosis?