Use of Plain Radiographs for Diabetic Foot Ulcer Surveillance: A Survey Analysis

The use of plain radiographs as a surveillance mechanism in diabetic foot ulcers (DFUs) is not well understood. This study aimed to investigate the current use of plain radiographs by podiatric physicians in various DFU clinical scenarios.

A survey was disseminated to American Podiatric Medical Association member podiatric physicians via a digital e-mail publication across a 2-week period in 2018. The Pearson χ2 test was used to detect differences between respondent groups for clinical scenarios in the survey.

The response rate was 4.5% (558 of 12,310). Seventy-seven percent of respondents were in private practice. For a DFU in a new patient, 66.8% of respondents "always" order plain radiographs, whereas for a new DFU in an established patient, only 46.5% of podiatric physicians "always" order plain radiographs. For an established DFU with underlying osteomyelitis, physicians with more than 5 years of practice experience order significantly more plain radiographs than physicians with less than 5 years of practice experience (P < .001). There was no association between practice experience and frequency of ordering plain radiographs for an established DFU without suspicion of osteomyelitis. For an established DFU, magnetic resonance imaging was the most common choice of secondary imaging modality if plain radiographs and clinical findings are equivocal.

Presence of underlying osteomyelitis, practice experience, and patient status (ie, new versus established) impact the decision about how frequently plain radiographs are ordered when considering DFU clinical scenarios. The results of this survey reflect the variation of plain radiograph use in diabetic foot management. Future qualitative studies may further explore factors that influence the decision to use plain radiographs.