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This guideline is on the prevention of foot ulceration in persons with diabetes and updates the 2015 IWGDF prevention guideline. We followed the GRADE methodology to devise clinical questions and critically important outcomes in the PICO format, to conduct a systematic review of the medical\u2010scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. We recommend to screen a person at very low risk for ulceration annually for loss of protective sensation and peripheral artery disease and persons at higher risk at higher frequencies for additional risk factors. For preventing a foot ulcer, educate the at\u2010risk patient about appropriate foot self\u2010care and treat any pre\u2010ulcerative sign on the foot. Instruct moderate\u2010to\u2010high risk patients to wear accommodative properly fitting therapeutic footwear, and consider instructing them to monitor foot skin temperature. Prescribe therapeutic footwear that has a demonstrated plantar pressure relieving effect during walking to prevent plantar foot ulcer recurrence. In patients that fail non\u2010surgical treatment for an active or imminent ulcer, consider surgical intervention; we suggest not to use a nerve decompression procedure. Provide integrated foot care for high\u2010risk patients to prevent ulcer recurrence. Following these recommendations will help health care professionals to provide better care for persons with diabetes at risk of foot ulceration, to increase the number of ulcer\u2010free days, and to reduce the patient and health care burden of diabetic foot disease.<\/jats:p>","DOI":"10.1002\/dmrr.3269","type":"journal-article","created":{"date-parts":[[2020,3,16]],"date-time":"2020-03-16T09:07:41Z","timestamp":1584349661000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":375,"title":["Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update)"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8357-9163","authenticated-orcid":false,"given":"Sicco A.","family":"Bus","sequence":"first","affiliation":[{"name":"Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine Amsterdam Movement Sciences Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence A.","family":"Lavery","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery University of Texas Southwestern Medical Center Dallas Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4586-2910","authenticated-orcid":false,"given":"Matilde","family":"Monteiro\u2010Soares","sequence":"additional","affiliation":[{"name":"MEDCIDES: Departamento de Medicina da Comunidade Informa\u00e7\u00e3o e Decis\u00e3o em Sa\u00fade and CINTESIS\u2014Center for Health Technology and Services Research Faculdade de Medicina da Universidade do Porto Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Rasmussen","sequence":"additional","affiliation":[{"name":"Steno Diabetes Center Copenhagen Gentofte Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Raspovic","sequence":"additional","affiliation":[{"name":"Discipline of Podiatry School of Allied Health, La Trobe University Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel C.N.","family":"Sacco","sequence":"additional","affiliation":[{"name":"Physical Therapy, Speech and Occupational Therapy department School of Medicine, University of S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6420-6046","authenticated-orcid":false,"given":"Jaap J.","family":"van Netten","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine Amsterdam Movement Sciences Amsterdam The Netherlands"},{"name":"School of Clinical Sciences Queensland University of Technology Brisbane Australia"},{"name":"Diabetic Foot Clinic, Department of Surgery Ziekenhuisgroep Twente Almelo and Hengelo The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the International Working Group on the Diabetic Foot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,16]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.13680"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12404"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12545"},{"key":"e_1_2_15_5_1","first-page":"2367","article-title":"Diabetic foot ulcers and their recurrence. 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