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Diabetic foot osteomyelitis — ABIM Board MCQ

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ModerateInfectious DiseaseDiabetic foot osteomyelitisABIM Board

A 61-year-old with diabetes has a chronic plantar ulcer that probes to bone. ESR is 88 mm/hour, plain radiographs are equivocal and he is hemodynamically stable. Which imaging study best evaluates suspected osteomyelitis?

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Correct answer: C — Obtain foot MRI to define marrow and soft-tissue involvement

The best answer is “Obtain foot MRI to define marrow and soft-tissue involvement”. When the diagnosis remains uncertain after examination, inflammatory markers and plain films, MRI best defines marrow infection and soft-tissue extent. A deep tissue or bone specimen—not a superficial swab—guides microbiology when needed. Nuclear imaging is an alternative when MRI is unavailable or contraindicated.

Reference: IWGDF/IDSA Guideline on Diabetes-related Foot Infections: https://www.idsociety.org/practice-guideline/diabetic-foot-infections/