Diabetic foot remains a challenge for the clinicians due to confusing clinical picture and associated complications. It may present as neuroarthropathy, septic arthritis, osteomyelitis, ischemic devitalised bone or as soft tissue complications such as cellulitis, myositis, ulceration, callus formation, sinus tracts, abscess, muscle denervation, tenosynovitis etc. Awareness of the various imaging findings of a diabetic foot, their relevance to the therapeutic decisions and correct usage of various imaging modalities to answer pertinent clinical questions are very important to improve the patient management and to reduce complications and morbidity.

Plain radiography is the preferred first line imaging investigation. It can show osseous structures and joint spaces well however it is neither sensitive nor specific. The detection rate and accuracy is low, especially in the scenario of early infection or neuroarthropathy, due to its lack of adequate demonstration of the soft tissues. In addition, Charcot’s foot and osteomyelitis may show overlapping radiographic features.

As foot infections in diabetic patients tend to be intractable, early introduction of therapy is paramount to prevent progression to gangrene and consequent amputation.

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