Individuals with long-standing diabetes are at high risk for developing devastating musculoskeletal complications including plantar ulcers, and Charcot arthropathy that can lead to amputation. A major obstacle for the development of effective treatments for musculoskeletal complications of diabetes is the lack of objective and reproducible tests to detect small changes in symptoms and signs seen in intervention studies. In this lecture, we will discuss how quantitative MRI methods can be help delineate the specific pathophysiological mechanisms that mediate the effectiveness of a treatment and identity patients who are responsive to an intervention.