Diabetes is a common disease with potentially devastating complications affecting the foot and ankle. A combination of vascular disease, peripheral neuropathy, and immunopathy result in a cascade of conditions including ischemia/infarction, tendinopathy, atrophy, edema, deformity, neuropathic osteoarthopathy, callus, ulceration, and infection. The MR imaging appearance of these complications will be discussed. Recognition of these MR imaging patterns facilitates formulation of medical or surgical treatment plans.