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A comprehensive analysis of reported interventions is needed to better inform healthcare professionals about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to help prevent both first and recurrent foot ulcers in persons with diabetes who are at risk for this complication. We searched the available medical scientific literature in PubMed, EMBASE, CINAHL, and the Cochrane databases for original research studies on preventative interventions. We screened trial registries for additional studies not found in our search and unpublished trials. Two independent reviewers assessed data from controlled studies for methodological quality, and extracted and presented this in evidence and risk of bias tables. From the 13,490 records screened, 35 controlled studies and 46 non\u2010controlled studies were included. Few controlled studies, which were of generally low to moderate quality, were identified on the prevention of a first foot ulcer. For the prevention of recurrent plantar foot ulcers, there is benefit for the use of daily foot skin temperature measurements, and for therapeutic footwear with demonstrated plantar pressure relief, provided it is consistently worn by the patient. For prevention of ulcer recurrence, there is some evidence for providing integrated foot care, and no evidence for a single session of education.Surgical interventions have been shown effective in selected patients, but the evidence base is small. Foot\u2010related exercises do not appear to prevent a first foot ulcer. A small increase in the level of weight\u2010bearing daily activities does not seem to increase the risk for foot ulceration. The evidence base to support the use of specific self\u2010management and footwear interventions for the prevention of recurrent plantar foot ulcers is quite strong. The evidence is weak for the use of other, sometimes widely applied, interventions, and is practically non\u2010existent for the prevention of a first foot ulcer and non\u2010plantar foot ulcer.<\/jats:p>","DOI":"10.1002\/dmrr.3270","type":"journal-article","created":{"date-parts":[[2020,1,20]],"date-time":"2020-01-20T07:19:35Z","timestamp":1579504775000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":106,"title":["Prevention of foot ulcers in the at\u2010risk patient with diabetes: a systematic review"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6420-6046","authenticated-orcid":false,"given":"Jaap J.","family":"van Netten","sequence":"first","affiliation":[{"name":"Amsterdam UMC University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9  Amsterdam The Netherlands"},{"name":"School of Clinical Sciences Queensland University of Technology  Brisbane Queensland Australia"},{"name":"Diabetic Foot Clinic, Department of Surgery Ziekenhuisgroep Twente  Almelo The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Raspovic","sequence":"additional","affiliation":[{"name":"Discipline of Podiatry, School of Allied Health, Human Services and Sport La Trobe University  Melbourne Victoria Australia"}],"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 &amp; CINTESIS \u2013 Center for Health Technology and Services Research, Faculdade de Medicina 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":"Isabel C. 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