Accepted Article This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/dme.13824 This article is protected by copyright. All rights reserved. DR FRANCISCO JAVIER ÁLVARO-AFONSO (Orcid ID : 0000-0003-4674-3822) PROFESSOR JOSÉ LUIS LÁZARO MARTÍNEZ (Orcid ID : 0000-0001-6110-0265) DR RAÚL MOLINES-BARROSO (Orcid ID : 0000-0002-7365-1387) Article type : Letter Corresponding Author Email ID: diabetes@ucm.es Title: Diabetic Medicine Created by: Maria Hale Email proofs to: alexander.seibold@abbott.com Copyright: Diabetes UK Article no.: DME-2018-00349 Article type: Letter Short title/Authors running head: Letter  Letter Letter Cortical disruption is the most reliable and accurate plain radiographic sign in the diagnosis of diabetic foot osteomyelitis The Infectious Diseases Society of America guidelines recommend that if film radiographies show classic changes suggestive of diabetic foot osteomyelitis, it is reasonable to initiate treatment for presumptive osteomyelitis [1]. No accuracy and reliability studies have stratified different radiographic signs in the diagnosis of diabetic foot osteomyelitis to determine the most reliable and accurate plain radiographic sign. This study aims to analyse the reliability and accuracy of four parameters of plain radiography in the diagnosis of diabetic foot osteomyelitis.