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Evidence summaries

Prevention of Foot Ulcers in Diabetics

Combined therapeutic footwear and daily foot skin temperature measurements appear to reduce recurrent ulcer morbidity. Level of evidence: "B"

A meta-analysis 3 included 17 RCTs involving 2729 participants. 4 tested home foot temperature monitoring, 6 examined patient education and 7 assessed offloading footwear. Participants who performed home foot temperature monitoring [odds ratio (OR) 0.51, 95% CI 0.31 to 0.84; n = 468] and those provided offloading footwear (OR 0.48, 95% CI 0.29 to 0.80; n = 1438) were less likely to develop a diabetes-related foot ulcer. Patient education programmes did not significantly reduce diabetes-related foot ulcer incidence (OR 0.59, 95% CI 0.29 to 1.20; n = 823). Sensitivity analyses suggested that offloading footwear findings were consistent, but home foot temperature findings were dependent on the individual inclusion of one trial.

A systematic review 2 assessing interventions to prevent first and recurrent foot ulcers in persons with diabetes who are at risk for ulceration included 30 controlled studies (19 RCTs) and another 44 non-controlled studies. For the prevention of recurrent plantar foot ulcers, multiple RCTs with low risk of bias show the benefit for the use of daily foot skin temperature measurements and consequent preventative actions, as well as for therapeutic footwear that demonstrates to relieve plantar pressure and that is worn by the patient. To prevent recurrence, some evidence exists for a combination of professional foot treatment, therapeutic footwear and patient education. For just a single session of patient education, no evidence exists. Surgical interventions can be effective in selected patients, but the evidence is insufficient.

Comment: The quality of evidence is downgraded by study quality.

References

  • van Netten JJ, Price PE, Lavery LA et al. Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review. Diabetes Metab Res Rev 2016;32 Suppl (1):84-98. [PubMed]
  • Alahakoon C, Fernando M, Galappaththy C, et al. Meta-analyses of randomized controlled trials reporting the effect of home foot temperature monitoring, patient education or offloading footwear on the incidence of diabetes-related foot ulcers. Diabet Med 2020;37(8):1266-1279 [PubMed]

Primary/Secondary Keywords