{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:15:26Z","timestamp":1783509326933,"version":"3.55.0"},"reference-count":25,"publisher":"MDPI AG","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9]]},"abstract":"\n Background:<\/jats:bold>\n 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.\n <\/jats:p>\n \n Methods:<\/jats:bold>\n 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 \u03c7\n 2<\/jats:sup>\n test was used to detect differences between respondent groups for clinical scenarios in the survey.\n <\/jats:p>\n \n Results:<\/jats:bold>\n 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 \u201calways\u201d order plain radiographs, whereas for a new DFU in an established patient, only 46.5% of podiatric physicians \u201calways\u201d 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 (\n P<\/jats:italic>\n < .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.\n <\/jats:p>\n \n Conclusions:<\/jats:bold>\n 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.\n <\/jats:p>","DOI":"10.7547\/23-014","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T13:37:24Z","timestamp":1761745044000},"source":"Crossref","is-referenced-by-count":0,"title":["Use of Plain Radiographs for Diabetic Foot Ulcer Surveillance: A Survey Analysis"],"prefix":"10.3390","volume":"115","author":[{"given":"Chia-Ding","family":"Shih","sequence":"first","affiliation":[{"name":"California School of Podiatric Medicine at Samuel Merritt University, Oakland, CA."},{"name":"Department of Vascular Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany T.","family":"Tran","sequence":"additional","affiliation":[{"name":"Santa Clara Medical Center, Kaiser Permanente, Santa Clara, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew Q.","family":"Dong","sequence":"additional","affiliation":[{"name":"St. Mary\u2019s Medical Center, San Francisco, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dyane E.","family":"Tower","sequence":"additional","affiliation":[{"name":"Clinical Affairs, American Podiatric Medical Association, Bethesda, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"B1","article-title":"Diabetes basics","unstructured":"Centers for Disease Control and Prevention: Diabetes basics. Available at: https:\/\/www.cdc.gov\/diabetes\/basics\/quick-facts.html. May 11, 2018. Accessed July 11, 2018."},{"issue":"suppl 1","key":"B2","series-title":"Diabetes Metab Res Rev","first-page":"e3266","article-title":"Practical guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update)","volume":"36","author":"Schaper NC","year":"2020","unstructured":"Schaper NC, van Netten JJ, Apelqvist J, et al: Practical guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev 36(suppl 1): e3266, 2020."},{"key":"B3","series-title":"JAPMA","first-page":"163","article-title":"Forecasting the value of podiatric medical care in newly insured diabetic patients during implementation of the Affordable Care Act in California","volume":"106","author":"Labovitz JM","year":"2016","unstructured":"Labovitz JM, Kominski GF: Forecasting the value of podiatric medical care in newly insured diabetic patients during implementation of the Affordable Care Act in California. JAPMA 106: 163, 2016."},{"key":"B4","series-title":"Int Wound J","first-page":"286","article-title":"Guest editorial: are diabetes-related wounds and amputations worse than cancer?","volume":"4","author":"Armstrong DG","year":"2007","unstructured":"Armstrong DG, Wrobel J, Robbins JM: Guest editorial: are diabetes-related wounds and amputations worse than cancer? Int Wound J 4: 286, 2007."},{"key":"B5","series-title":"Diabetes Care","first-page":"2021","article-title":"Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade","volume":"35","author":"Morbach S","year":"2012","unstructured":"Morbach S, Furchert H, Gr\u00f6blinghoff U, et al: Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade. Diabetes Care 35: 2021, 2012."},{"key":"B6","first-page":"2030","unstructured":"Healthy People 2030. Available at: https:\/\/health.gov\/healthypeople. Accessed September 7, 2020."},{"key":"B7","article-title":"Reduce the proportion of adults with diabetes who have an A1c value above 9 percent","unstructured":"Healthy People 2030: Reduce the proportion of adults with diabetes who have an A1c value above 9 percent. Available at: https:\/\/odphp.health.gov\/healthypeople\/objectives-and-data\/browse-objectives\/diabetes\/reduce-proportion-adults-diabetes-who-have-a1c-value-above-9-percent-d-03\/data."},{"key":"B8","series-title":"Diabetes Care","first-page":"645","article-title":"Current challenges and opportunities in the prevention and Management of diabetic foot ulcers","volume":"41","author":"Jeffcoate WJ","year":"2018","unstructured":"Jeffcoate WJ, Vileikyte L, Boyko EJ, et al: Current challenges and opportunities in the prevention and Management of diabetic foot ulcers. Diabetes Care 41: 645, 2018."},{"key":"B9","article-title":"Atlases and reports. Dartmouth Atlas of Health Care","unstructured":"Curtis-Hill K: Atlases and reports. Dartmouth Atlas of Health Care. https:\/\/www.dartmouthatlas.org\/atlases-and-reports. Published July 24, 2018. Accessed July 4, 2022."},{"issue":"suppl 1","key":"B10","series-title":"Diabetes Metab Res Rev","first-page":"45","article-title":"IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes","volume":"32","author":"Lipsky BA","year":"2016","unstructured":"Lipsky BA, Arag\u00f3n-S\u00e1nchez J, Diggle M, et al: IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev 32(suppl 1): 45, 2016."},{"issue":"suppl 1","key":"B11","series-title":"Diabetes Metab Res Rev","first-page":"75","article-title":"IWGDF guidance on use of interventions to enhance the healing of chronic ulcers of the foot in diabetes","volume":"32","author":"Game FL","year":"2016","unstructured":"Game FL, Attinger C, Hartemann A, et al: IWGDF guidance on use of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev 32(suppl 1): 75, 2016."},{"key":"B12","series-title":"Q J Nucl Med Mol Imaging","first-page":"33","article-title":"Diagnosing diabetic foot infection: the role of imaging and a proposed flow chart for assessment","volume":"58","author":"Israel O","year":"2014","unstructured":"Israel O, Sconfienza LM, Lipsky BA: Diagnosing diabetic foot infection: the role of imaging and a proposed flow chart for assessment. Q J Nucl Med Mol Imaging 58: 33, 2014."},{"key":"B13","series-title":"Clin Infect Dis","first-page":"e132","article-title":"Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections","volume":"54","author":"Lipsky BA","year":"2012","unstructured":"Lipsky BA, Berendt AR, Cornia PB, et al: 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 54: e132, 2012."},{"key":"B14","series-title":"To Err Is Human: Building a Safer Health System","article-title":"Committee on Quality of Health Care in America","year":"2000","unstructured":"Institute of Medicine, Committee on Quality of Health Care in America. To Err Is Human: Building a Safer Health System. National Academies Press; 2000."},{"issue":"suppl 3","key":"B15","series-title":"J Gen Intern Med","first-page":"S555","article-title":"Factors contributing to variations in physicians\u2019 use of evidence at the point of care: a conceptual model","volume":"30","author":"Reschovsky JD","year":"2015","unstructured":"Reschovsky JD, Rich EC, Lake TK: Factors contributing to variations in physicians\u2019 use of evidence at the point of care: a conceptual model. J Gen Intern Med 30(suppl 3): S555, 2015."},{"key":"B16","series-title":"Soc Sci Med","first-page":"1728","article-title":"What do physicians gain (and lose) with experience? qualitative results from a cross-national study of diabetes","volume":"70","author":"Elstad EA","year":"2010","unstructured":"Elstad EA, Lutfey KE, Marceau LD, et al: What do physicians gain (and lose) with experience? qualitative results from a cross-national study of diabetes. Soc Sci Med 70: 1728, 2010."},{"key":"B17","series-title":"N Engl J Med","first-page":"2635","article-title":"The quality of health care delivered to adults in the United States","volume":"348","author":"McGlynn EA","year":"2003","unstructured":"McGlynn EA, Asch SM, Adams J, et al: The quality of health care delivered to adults in the United States. N Engl J Med 348: 2635, 2003."},{"key":"B18","series-title":"Radiology","first-page":"240","article-title":"Addressing overutilization in medical imaging","volume":"257","author":"Hendee WR","year":"2010","unstructured":"Hendee WR, Becker GJ, Borgstede JP, et al: Addressing overutilization in medical imaging. Radiology 257: 240, 2010."},{"key":"B19","series-title":"JAMA","first-page":"983","article-title":"The real cost of the US health care system","volume":"319","author":"Emanuel EJ","year":"2018","unstructured":"Emanuel EJ: The real cost of the US health care system. JAMA 319: 983, 2018."},{"key":"B20","series-title":"JAMA","first-page":"1024","article-title":"Health care spending in the United States and other high-income countries","volume":"319","author":"Papanicolas I","year":"2018","unstructured":"Papanicolas I, Woskie LR, Jha AK: Health care spending in the United States and other high-income countries. JAMA 319: 1024, 2018."},{"key":"B21","series-title":"Arch Intern Med","first-page":"1525","article-title":"Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: playing by the rules","volume":"169","author":"McCabe C","year":"2009","unstructured":"McCabe C, Kirchner C, Zhang H, et al: Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: playing by the rules. Arch Intern Med 169: 1525, 2009."},{"key":"B22","series-title":"Int J Surg","first-page":"1317","article-title":"An overview of the use and implementation of checklists in surgical specialities: a systematic review","volume":"12","author":"Patel J","year":"2014","unstructured":"Patel J, Ahmed K, Guru KA, et al: An overview of the use and implementation of checklists in surgical specialities: a systematic review. Int J Surg 12: 1317, 2014."},{"key":"B23","series-title":"Eur J Pediatr","first-page":"47","article-title":"Reducing unnecessary chest X-rays, antibiotics, and bronchodilators through implementation of the NICE bronchiolitis guideline","volume":"177","author":"Breakell R","year":"2018","unstructured":"Breakell R, Thorndyke B, Clennett J, et al: Reducing unnecessary chest X-rays, antibiotics, and bronchodilators through implementation of the NICE bronchiolitis guideline. Eur J Pediatr 177: 47, 2018."},{"key":"B24","series-title":"Cancer","first-page":"1593","article-title":"Association between adherence to National Comprehensive Cancer Network treatment guidelines and improved survival in patients with colon cancer","volume":"119","author":"Boland GM","year":"2013","unstructured":"Boland GM, Chang GJ, Haynes AB, et al: Association between adherence to National Comprehensive Cancer Network treatment guidelines and improved survival in patients with colon cancer. Cancer 119: 1593, 2013."},{"key":"B25","series-title":"Health Aff","first-page":"710","article-title":"Hospital employment of physicians in Massachusetts is associated with inappropriate diagnostic imaging","volume":"40","author":"Young GJ","year":"2021","unstructured":"Young GJ, Zepeda ED, Flaherty S, et al: Hospital employment of physicians in Massachusetts is associated with inappropriate diagnostic imaging. Health Aff 40: 710, 2021."}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/japmaonline.org\/view\/journals\/apms\/115\/5\/23-014.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/115\/5\/23-014.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/115\/5\/23-014.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:20:17Z","timestamp":1783506017000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/115\/5\/23014"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":25,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.7547\/23-014","relation":{},"ISSN":["8750-7315"],"issn-type":[{"value":"8750-7315","type":"print"}],"subject":[],"published":{"date-parts":[[2025,9]]}}}