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To determine the usefulness of primary and secondary magnetic resonance (MR) imaging signs of osteomyelitis. MR imaging at 1.5 T was performed in 73 feet (62 patients) with clinical concern for osteomyelitis. Images were reviewed retrospectively and separately by two reviewers in a blinded fashion for primary (abnormal marrow signal intensity) and secondary (ulcer, cellulitis, soft-tissue mass, abscess, sinus tract, cortical interruption) signs associated with osteomyelitis. Of the 73 feet, 43 had osteomyelitis. Discordant marrow signal intensity between individual MR sequences was observed by reader 1 in six (8%) feet and by reader 2 in 15 (21%) feet. For primary signs, fast spin-echo short inversion time inversion-recovery and gadolinium-enhanced fat-suppressed T1-weighted images had the highest sensitivity, and T1-weighted and gadolinium-enhanced fat …