What is the role of plain radiographs in the workup of diabetic foot ulcers?

Updated: Oct 15, 2020
  • Author: Tanzim Khan, DPM; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Plain radiographs should be obtained in the setting of diabetic foot ulcers, as well as pre-ulcerative lesions. Weight-bearing radiographs of the foot are preferred, and three views are typically ordered. Radiography allows clinicians to assess for deformities that may be the driving force for ulcerations. Osteomyelitis can often be detected on plain radiographs; however, the images may appear normal in the first 2 weeks of the disease process. Soft tissue gas may be present in the setting of gas gangrene and necrotizing soft tissue infections, which require prompt surgical intervention.

Radiographs may demonstrate calcifications of extremity vasculature. However, arterial calcification seen on plain radiographs is not a specific indicator of severe atherosclerotic disease. Calcification of the arterial media is not diagnostic of atherosclerosis, and even calcification of the arterial intima, which is diagnostic of atherosclerotic disease, does not necessarily imply hemodynamically significant stenosis.

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