 Introduction/Background The Centers for Disease Control and Prevention National Diabetes Statistics Report of 2017 states that 30.3 million people in the United States have diabetes (9.4% of the population) [1]. Diabetes-related foot complications, such as soft-tissue infection, osteomyelitis, and neuropathic osteoarthropathy, account for up to 20% of all diabetic-related North American hospital admissions, with up to $1.5 billion spent annually in the United States on diabetic foot ulcer care [2]. Neuropathic changes in the foot are present in about 1% of diabetics [3]. Neuropathic osteoarthropathy is a progressive process affecting the bones, joints, and soft tissue of the foot and ankle. Delay in the diagnosis may lead to derangement of the bony architecture of the foot, deformity, recurrent foot ulcerations, cellulitis, osteomyelitis, and amputation [4]. Discussion of Procedures by Variant Variant 1: Suspected osteomyelitis of the foot in patients with diabetes mellitus. Initial imaging. Radiography Foot Radiographs are useful as the initial screening examination. They evaluate anatomic detail and previous surgeries and are useful to evaluate for other causes of pain, such as radiopaque foreign body, soft-tissue gas, fracture, degenerative changes, neuropathic arthropathy, or tumor. Radiographs are insensitive in the detection of early stages of acute osteomyelitis [11]. Soft-tissue swelling and obscuration of the fat planes will precede osseous changes [12]. Osseous changes may take 10 to 12 days to develop in adults [13]. Early bony changes of osseous infection include periosteal reaction, lytic bone destruction, endosteal scalloping, osteopenia, loss of trabecular architecture, and new bone apposition [13]. CT Foot There is no relevant literature to support the use of CT with or without intravenous (IV) contrast as the initial screening examination in diabetic patients with suspected osteomyelitis of the foot.
Suspected Osteomyelitis of the Foot in Patients with Diabetes Mellitus.  Introduction/Background The Centers for Disease Control and Prevention National Diabetes Statistics Report of 2017 states that 30.3 million people in the United States have diabetes (9.4% of the population) [1]. Diabetes-related foot complications, such as soft-tissue infection, osteomyelitis, and neuropathic osteoarthropathy, account for up to 20% of all diabetic-related North American hospital admissions, with up to $1.5 billion spent annually in the United States on diabetic foot ulcer care [2]. Neuropathic changes in the foot are present in about 1% of diabetics [3]. Neuropathic osteoarthropathy is a progressive process affecting the bones, joints, and soft tissue of the foot and ankle. Delay in the diagnosis may lead to derangement of the bony architecture of the foot, deformity, recurrent foot ulcerations, cellulitis, osteomyelitis, and amputation [4]. Discussion of Procedures by Variant Variant 1: Suspected osteomyelitis of the foot in patients with diabetes mellitus. Initial imaging. Radiography Foot Radiographs are useful as the initial screening examination. They evaluate anatomic detail and previous surgeries and are useful to evaluate for other causes of pain, such as radiopaque foreign body, soft-tissue gas, fracture, degenerative changes, neuropathic arthropathy, or tumor. Radiographs are insensitive in the detection of early stages of acute osteomyelitis [11]. Soft-tissue swelling and obscuration of the fat planes will precede osseous changes [12]. Osseous changes may take 10 to 12 days to develop in adults [13]. Early bony changes of osseous infection include periosteal reaction, lytic bone destruction, endosteal scalloping, osteopenia, loss of trabecular architecture, and new bone apposition [13]. CT Foot There is no relevant literature to support the use of CT with or without intravenous (IV) contrast as the initial screening examination in diabetic patients with suspected osteomyelitis of the foot.