Radiologic evaluation and vascular management of diabetes-related foot infection: a narrative review

Diabetes-related foot infection (DFI) is a serious complication of diabetes mellitus that can lead to lower extremity amputation. This narrative review synthesizes the radiological evaluation and management of DFI, focusing on multimodal imaging strategies that support accurate diagnosis, treatment planning, and limb salvage. Plain radiography is the initial imaging tool for detecting early soft tissue swelling and osseous destruction. In patients with peripheral artery disease, computed tomography angiography and digital subtraction angiography provide complementary information for vascular mapping and image-guided endovascular revascularization, including angioplasty, to improve perfusion and minimize amputation. Magnetic resonance imaging (MRI) remains the preferred modality for confirming osteomyelitis, assessing the extent of infection, identifying devitalized tissues, and differentiating it from Charcot neuroarthropathy. An integrated approach that combines clinical assessment, plain radiography, vascular imaging, and MRI supports precise preoperative planning, optimizes limb-salvage strategy, and may reduce the number of major amputations in high-risk populations.