Beyond the Monofilament for the Insensate Diabetic Foot

Foot ulcers in patients with diabetes lead to infections, amputations, and high costs, and their prevention is a stated goal of the American Diabetes Association. To assess the benefits of various interventions on the prevention of future diabetic foot ulcers, we searched for and reviewed all randomized clinical trials (RCTs) on the prevention of diabetic foot ulcers and evaluated their efficacy and scientific validity on the basis of an established systemic grading system. Only 13 RCTs were identified. All involved secondary prevention or a mixture of primary and secondary prevention. Most were small and of poor quality, with negative studies generally being of better quality than positive studies. Of all methods proposed to prevent diabetic foot ulcers, only foot temperature-guided avoidance therapy was found beneficial in RCTs, although this needs to be validated in other populations. These observations only apply to high-risk populations, and the benefits to the general population with diabetes are unclear.