Brian P. Scharfstein, C. Ped (C)
Foothealth Centre
Winnipeg, MB

Introduction
Diabetes is a multi-system condition leading to multiple end organ complications. Peripheral neuropathy is the key factor leading to the lower extremity complications of diabetes. These lower extremity complications include loss of protective sensation which leads to ulcerations, Charcot changes and there may also be associated neuropathic pain.

Gerhard W. Bock, M.D., FRCPC¹,
John M. Embil, M.D., FRCPC²

1. Department of Radiology, University of Manitoba, Winnipeg, MB
2. Department of Medicine, Section of Infectious Diseases, University of Manitoba, Winnipeg, MB

Introduction
Osteomyelitis is a common complication in the foot of persons with diabetes, affecting approximately 15% of patients. Acute contiguous focus osteomyelitis is the most commonly observed form of osteomyelitis in the diabetic foot. This review will consider the pathophysiology of the diabetic foot as it relates to radiologic imaging, present the various radiologic imaging techniques available, and suggest an algorithmic approach to the radiographic imaging evaluation of the diabetic foot.

Joshua Koulack, MSc, M.D., FRCS
Section of Vascular Surgery, Department of Surgery, University of Manitoba,
Winnipeg, MB

Introduction
It has been well established that persons with diabetes have a greater prevalence and severity of peripheral vascular disease (PVD) than the general population. More than 80% of persons with diabetes for more than 20 years will develop some form of vascular disease and 75% will die as a result of complications from vascular disease1 such as stroke or myocardial infarction. Both large and small vessels are affected, which can contribute, alone or in concert with the often-encountered sensorimotor polyneuropathy, to the complications seen in the feet of persons with diabetes.

Mary K. Nagai, M.D., PhD
Frank Duerksen, M.D., FRCSC
Section of Orthopaedic Surgery, Department of Surgery
University of Manitoba,
Winnipeg, MB

Introduction
Neuropathic osteoarthropathy is a late complication of peripheral neuropathy of the foot and ankle. A Charcot foot has several distinct characteristics. It is a non-infective, destructive lesion of a bone and joint with collapse of joint spaces, often accompanied by a fracture and/or dislocation of one or more ankle and foot joints in a patient who has peripheral neuropathy.¹ The tarsal-metatarsal and tarsal joints are most commonly affected. It is a common and difficult complication of diabetes mellitus to treat. The Eichenholtz classification scheme for the Charcot foot is shown in Table 1.^1,2