A systematic review including 13 RCTs (n=4480) and 3 prospective studies (n=1033) with a total of subjects was abstracted in DARE. Intensive, prompted patient education may reduce foot complications over relative short periods of time. One trial (n=2001) on screening and intervention for patients with feet at raised risk of ulceration showed some effectiveness. It was suggested that monofilaments provide a cost-effective alternative to first line monitoring for neuropathy.
Another systematic review 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.