Foot care education for the prevention of diabetic foot ulcers

Diabetic foot ulcers represent a major complication of diabetes and contribute substantially to the risk of lower-limb amputation. Although educational strategies focused on foot care are commonly recommended as preventive measures, the available evidence varies considerably in methodological design and clinical context. This systematic review was conducted in accordance with PRISMA 2020 and examined studies published between 2018 and 2026, identified through Scopus, PubMed, OpenAlex, and Crossref. Eligible investigations evaluated structured foot care education among individuals with diabetes using randomized, quasi-experimental, or observational designs. A total of 18 studies involving 1,531 participants met the inclusion criteria, comprising five randomized controlled trials, twelve quasi-experimental investigations, and one observational cohort study. Across the included studies, educational interventions were consistently associated with improvements in foot care knowledge and self-management practices. However, only two investigations assessed outcomes directly related to ulceration or its complications. One randomized trial detected no difference in the occurrence of new ulcers following group-based education, while an observational cohort identified an association between previous educational exposure and lower rates of amputation and infection. Most quasi-experimental studies presented a high risk of bias, limiting confidence in their findings. Overall, structured foot care education appears effective in strengthening patients' knowledge and self-care behaviors, whereas its capacity to prevent diabetic foot ulcer development remains insufficiently demonstrated by the available low-certainty evidence.