**2.4 Musculoskeletal**

The musculoskeletal assessment involves looking for common foot abnormalities such bunions (hallux valgus), constricted toes and Tailor's bunions (lateral exostosis fifth metatarsal head). With the patient upright, clinicians should look for any noticeable asymmetry changes in arch height. Common symptoms of a patient's foot "looking odd" or changing in appearance and becoming red, hot and swollen without any history of trauma to the region should prompt a radiograph and referral to a podiatrist for treatment. Unexplained swelling in the feet is a sign of active Charcot alterations, especially if just one foot is affected. Diabetic foot infection, osteomyelitis and cellulitis, acute inflammatory arthropathy, gout, acute thrombosis and trauma are all causes of a Charcot deformity [20].

### **2.5 Imaging**

In an acute presentation of a DFU, plain radiography is the most frequent firstline radiographic study to check for underlying osteomyelitis. It is cheap and widely available. If feasible, weighty viewpoints should be taken. Radiographs can identify osteomyelitis, osteolysis, fractures, dislocations, medial arterial calcification, soft tissue gas and foreign substances, as well as structural foot abnormalities and the presence of arthritis [20]. CT scans may be used to evaluate suspected bone and joint disease that is not visible on conventional radiography. CT provides excellent anatomic information and resolution of bone, including osseous fragmentation and joint subluxation. Subluxation of the transverse tarsal or tarsometatarsal joints can be seen prior to being visualised on radiographs [21]. Because of its enhanced resolution and ability to visualise the extent of any infectious process, MRI is usually preferred over CT for the investigation of osteomyelitis. MRI is frequently used in evaluating both soft tissue and bone pathology. This scan may be used to help diagnose osteomyelitis, deep abscesses, septic joints and tendon rupture. MRI is particularly sensitive for bone infection and may also be utilised for surgical planning [22].
