Introduction: Labelled leukocyte scintigraphy has been shown to be a sensitive and specific technique for the detection of pedal osteomyelitis in patients with diabetes mellitus. There has however been little data relating the efficacy of the technique to outcomes.

Aim: To examine the prognostic value of sequential 99m Tc labelled leukocyte scans at diagnosis and after 3–4 weeks of appropriate antibiotic therapy.

Method: Twenty-three patients with proven pedal osteomyelitis or persistent uptake on the sequence of scans were studied.

Results: Five additional episodes of osteomyelitis developed in the group over the period of the study. Eleven patients demonstrated persistent uptake in the sequential scans. Nine progressed to amputation. The remaining two patients were biopsy negative for infection, did not have cutaneous ulceration and were thought to have rapidly progressive arthropathy.

Conclusion: Sequential leukocyte scintigraphy accurately predicted the need for amputation and circumvented ineffective prolonged antibiotic therapy.