X rays will show the bony destruction associated later in the course of the disorder. However, early disease may have no radiographic changes. The forefoot may show osteolysis of the phalanges. In the midfoot and hindfoot, osseous fragmentation, sclerosis, and subluxations are more common. ESR should be normal. MRI and bone scan may be non-diagnostic.
A priority is distinguishing from other threatening disorders such as gout, osteomyelitis, and septic arthritis. Joint effusions should be aspirated for this reason. Infection should be suspected when edema and erythema do not improve with foot elevation.