Our colleagues from Lund, Sweden, have just added a valuable new data point to a growing conversation about the role—and risks—of imaging in Charcot foot care. Their retrospective cohort study, published in the Journal of Foot and Ankle Research, analyzed 143 Charcot events in 122 individuals, comparing those who were monitored using follow-up MRI with those managed primarily through clinical and thermometric assessment alone .
The findings? Patients who underwent follow-up MRI spent significantly more time in total contact casts (TCC)—with initial durations nearly doubling (137 vs. 72 days) and overall time to full ambulation also substantially prolonged (median 445 vs. 276 days; p < 0.001) . Despite this, rates of surgical intervention and amputation did not improve in the MRI group. In fact, there was a numerical (though statistically nonsignificant) trend toward more partial and above-ankle amputations in the non-MRI group, likely explained by longer follow-up time in that cohort.
The takeaway? In real-world practice, more imaging didn’t equate to better outcomes—but it did appear to increase complexity, cost, and duration of care. This is where the idea of VOMIT—Victim of Modern Imaging Technology—comes sharply into focus.
As discussed in a prior post here, VOMIT describes the scenario where imaging findings—particularly those that are equivocal or of uncertain clinical significance—drive further testing, treatment delays, or even overtreatment. In the Lund study, one-third of MRI reports were discordant with thermometric findings, and in nearly half of those instances, clinicians deferred to the imaging report over the clinical signs .
That reflex—“waiting on the MRI”—can inadvertently extend immobilization, even when clinical improvement is evident. It’s worth noting that bone marrow edema (BMO), the primary marker used on MRI, can persist well beyond clinical remission. This mismatch between imaging and clinical resolution has been recognized before, but remains poorly integrated into standardized care pathways .
So what’s the right role for follow-up MRI in Charcot? The Lund team suggests that serial MRIs might best be reserved for specific situations—like suspected relapse or osteomyelitis—rather than as a routine surveillance tool. In other words: use imaging to answer a question, not to prolong the question.
Their conclusion aligns with 2023 IWGDF guidelines, which call for thoughtful integration of clinical exam, thermometry, and imaging, rather than automatic escalation to advanced imaging in ambiguous cases. As we aim to reduce the burden of Charcot foot—not just through limb preservation, but through quality, dignity-preserving care—we must remain wary of becoming victims of our own technology.
Citation:
Schoug J, Katzman P, Uddman E, Löndahl M. “Follow‐Up Magnetic Resonance Imaging in Monitoring Charcot Foot and Its Association With Total Contact Cast Treatment Duration and Long‐Term Outcomes: A Retrospective Cohort Study,” J Foot Ankle Res. 2025;18:e70058. doi:10.1002/jfa2.70058
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