The diabetic foot is "common foot problems in persons with diabetes mellitus, caused by any combination of factors such as diabetic neuropathies; peripheral vascular diseases; and infection. With the loss of sensation and poor circulation, injuries and infections often lead to severe foot ulcers, gangrene and amputation."
The signs of underlying osteomyelitis are "an ulcer area larger than 2 cm2, a positive probe-to-bone test result, an erythrocyte sedimentation rate of more than 70 mm/h, and an abnormal plain radiograph" according to a systematic review by the Rational Clinical Examination. A normal magnetic resonance imaging makes osteomyelitis unlikely.
The National Institute for Health and Clinical Excellence (NICE) has addressed screening and recommends annually:
Physical examination of patients’ feet:
- testing of foot sensation using a 10 g monofilament or vibration
- palpation of foot pulses
- inspection of any foot deformity and footwear
If screening with the monofilament is done, a three site test of the plantar surfaces of the great toe, the third metatarsal, and the fifth metatarsalsis is adequate according to a systematic review of studies. Another systematic review questions the test accuracy of the monofilament exam.
"Integrated foot risk scores are more sensitive than individual clinical criteria in predicting future foot ulceration and are likely to be better screening tools." 
An example of a foot risk score is the Scottish foot ulcer risk score. Low risk is defined as able to detect at least one pulse per foot, and able to feel 10 g monofilament, and no foot deformity, physical, or visual impairment. The negative predictive value of a 'low-risk score' is 99%. 
• general medicine practice
|Patient and provider education||Usual care||• Any foot lesion
• Serious foot lesions at one year
|Not reported||• 11%
• Significant reduction
• Prior ulceration
• specialist clinic
|Targeted, one-to-one education||Usual care||Re-ulceration at
• 1 year
• general diabetic clinic
|Screening and referral to foot-care clinic if they had prior ulcer, had low ankle–brachial index (<0.75), or had foot deformities||Usual care||• Ulceration within 2 years
• Amputation rates
• Prior ulceration
• Excluded severe deformity
|Therapeutic shoes||Usual footwear||Re-ulceration||15%||17%||Insignificant difference|
Other trials of lesser quality are available.  The trial by Donohoe had the following problems: 1) did not define high risk foot and the outcome of appropriate referral likely had incorporation bias due to the monofilament being part of the criteria, 2) non-randomized comparison of referrals, 3) imbalanced study size the hurt the power of the nonrandomized assessment of the control group.
"Of all methods proposed to prevent diabetic foot ulcers, only foot temperature-guided avoidance therapy was found beneficial in RCTs" according to a meta-analysis. Three trials are available.
"Currently there is no research evidence to suggest that any type of hydrocolloid wound dressing is more effective in healing diabetic foot ulcers than other types of dressing" according to the Cochrane Collaboration. 
"There is some evidence to suggest that hydrogel dressings are more effective in healing (lower grade) diabetic foot ulcers than basic wound contact dressings however this finding is uncertain due to risk of bias in the original studies" according to a meta-analysis by the Cochrane Collaboration. 
- Anonymous (2023), Diabetic foot (English). Medical Subject Headings. U.S. National Library of Medicine.
- Sonia Butalia et al., “Does This Patient With Diabetes Have Osteomyelitis of the Lower Extremity?,” JAMA 299, no. 7 (February 20, 2008): 806-813.
- (2004) CG10 Type 2 diabetes - footcare. National Institute for Health and Clinical Excellence
- Kaiser Permanente Care Management Institute. Guidelines for the management of adult diabetes in Primary Care. Oakland (CA): Kaiser Permanente Care Management Institute; 2006. 10 p. National Guidelines Clearinghouse
- Singh N, Armstrong DG, Lipsky BA (2005). "Preventing foot ulcers in patients with diabetes.". JAMA 293 (2): 217-28. DOI:10.1001/jama.293.2.217. PMID 15644549. Research Blogging.
- Kanji JN, Anglin RE, Hunt DL, Panju A (2010). "Does this patient with diabetes have large-fiber peripheral neuropathy?". JAMA 303 (15): 1526-32. DOI:10.1001/jama.2010.428. PMID 20407062. Research Blogging. Review in: Ann Intern Med. 2010 Oct 19;153(8):JC4-10
- Litzelman DK, Slemenda CW, Langefeld CD, Hays LM, Welch MA, Bild DE et al. (1993). "Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus. A randomized, controlled trial.". Ann Intern Med 119 (1): 36-41. PMID 8498761.
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