BACKGROUND: Diabetes mellitus continues to grow in global prevalence and to 
consume an increasing amount of health care resources. One of the key areas of 
morbidity associated with diabetes is the diabetic foot. To improve the care of 
patients with diabetic foot and to provide an evidence-based multidisciplinary 
management approach, the Society for Vascular Surgery in collaboration with the 
American Podiatric Medical Association and the Society for Vascular Medicine 
developed this clinical practice guideline.
METHODS: The committee made specific practice recommendations using the Grades 
of Recommendation Assessment, Development, and Evaluation system. This was based 
on five systematic reviews of the literature. Specific areas of focus included 
(1) prevention of diabetic foot ulceration, (2) off-loading, (3) diagnosis of 
osteomyelitis, (4) wound care, and (5) peripheral arterial disease.
RESULTS: Although we identified only limited high-quality evidence for many of 
the critical questions, we used the best available evidence and considered the 
patients' values and preferences and the clinical context to develop these 
guidelines. We include preventive recommendations such as those for adequate 
glycemic control, periodic foot inspection, and patient and family education. We 
recommend using custom therapeutic footwear in high-risk diabetic patients, 
including those with significant neuropathy, foot deformities, or previous 
amputation. In patients with plantar diabetic foot ulcer (DFU), we recommend 
off-loading with a total contact cast or irremovable fixed ankle walking boot. 
In patients with a new DFU, we recommend probe to bone test and plain films to 
be followed by magnetic resonance imaging if a soft tissue abscess or 
osteomyelitis is suspected. We provide recommendations on comprehensive wound 
care and various débridement methods. For DFUs that fail to improve (>50% wound 
area reduction) after a minimum of 4 weeks of standard wound therapy, we 
recommend adjunctive wound therapy options. In patients with DFU who have 
peripheral arterial disease, we recommend revascularization by either surgical 
bypass or endovascular therapy.
CONCLUSIONS: Whereas these guidelines have addressed five key areas in the care 
of DFUs, they do not cover all the aspects of this complex condition. Going 
forward as future evidence accumulates, we plan to update our recommendations 
accordingly.