ACR Appropriateness Criteria® Suspected Osteomyelitis of the Foot in Patients With Diabetes Mellitus

Expert Panel on Musculoskeletal Imaging:

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10 Scopus citations


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. Radiography of the foot is usually appropriate as the initial screening examination in diabetic patients with suspected osteomyelitis of the foot. For follow-up examination, MRI of the foot with or without contrast enhancement demonstrates excellent soft-tissue contrast and sensitivity to marrow abnormalities with high-resolution detail in multiple anatomic planes and is usually appropriate when osteomyelitis or early neuropathic arthropathy is suspected. This publication of diabetes-related foot complications summarizes the literature and makes recommendations for imaging based on the available data. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Original languageEnglish
Pages (from-to)S440-S450
JournalJournal of the American College of Radiology
Issue number11
StatePublished - Nov 2019


  • AUC
  • Appropriate Use Criteria
  • Appropriateness Criteria
  • Charcot foot
  • Diabetic foot
  • Foot osteomyelitis
  • Neuropathic osteoarthropathy
  • Soft-tissue ulcer
  • Ulcer


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