ABSTRACT

Diabetes is the leading cause of hospitalized foot infections and lower extremity amputations. The infection usually shows up as an ulcer in the soft tissue and invades to the bone underneath. Development of osteomyelitis significantly increases the rate of extremity amputation. A definite diagnosis of osteomyelitis can be withheld by histopathological, microbiological and radiological investigation of affected body part. Imaging of the diabetic foot aims primarily to define and grade the anatomical deformity, and to rule out the infection. Main purpose of imaging is to differentiate neuropathic arthropathy from infection. Neuropathic arthropathy causes magnetic resonance imaging signal changes and deformities initially in bony structures, and progress with periarticular inflammation; while infection requires the presence of a callus or ulcer that causes loss of skin integrity. Direct radiographs are the basis of preliminary imaging; however, magnetic resonance imaging has proved to be a better modality due to its high resolution for soft-tissues and also illustrating necrotic bony fragments as well as abscesses and fistulous tracts. In this review the clinical, laboratory and imaging methods in the diagnosis and particularly the contribution of nuclear imaging modalities are discussed.