A closed diabetic foot ulcer can look like a finish line. Biologically, it is more like a hard-won ceasefire.
The skin may be intact, but neuropathy, deformity, repetitive pressure, scar fragility, vascular disease, and the everyday difficulty of sustaining protective behaviors have not disappeared. This is why “remission” is more honest—and more useful—than “healed.” It reminds us that the absence of an open wound is not the absence of risk.
A newly published narrative review by Cesare Miranda, Valerio Velardi, and Roberto Da Ros makes that residual risk visible. Across the preventive strategies they examined, recurrence still ranged from 16.7% to 41.4%. Better glucose control, therapeutic footwear, home temperature monitoring, structured education, and treatment of pre-ulcerative lesions all matter. None, by itself, makes recurrence vanish.
One finding stands out because it turns something that may look administrative—the interval between visits—into something clinical.
The interval may be part of the dose
The review highlights the DIATIME randomized clinical trial, which enrolled 148 high-risk people in remission after a healed plantar foot ulcer and followed them for one year. Participants were assigned to podiatric screening and foot care every 4, 8, or 12 weeks.
The comparison was unusually clean. All three groups received therapeutic footwear with rigid rocker soles and custom-made insoles. All received podiatric care, including management of hyperkeratosis and nail care. The principal difference was cadence: callus care and screening occurred monthly, every two months, or every three months.
The reported one-year plantar-ulcer recurrence rates were:
- Every 4 weeks: 18.4%
- Every 8 weeks: 28.6%
- Every 12 weeks: 46.0%
The between-group difference was statistically significant. In this population, the shortest interval had the lowest recurrence.
That is more than a scheduling result. It suggests that, during remission, time itself can become a risk factor.
Why might four weeks matter?
Recurrence rarely arrives as a bolt from a blue sky. Pressure accumulates. Callus reforms. A blister, hemorrhage, fissure, or area of inflammation appears. In an insensate foot, these changes can advance without the usual alarm system of pain.
Frequent podiatric review creates more opportunities to interrupt that sequence while the problem is still small: identify a pre-ulcerative lesion, remove callus, inspect footwear, reassess pressure and fit, reinforce protective behavior, and escalate vascular or surgical evaluation when needed.
Think of the appointment interval as part of the therapeutic dose. The content of care matters, but so does whether it arrives before tissue stress crosses the line into breakdown.
This does not make podiatry a substitute for therapeutic footwear, daily inspection, glucose management, temperature monitoring, activity modification, or multidisciplinary care. It makes podiatry the recurring point at which those interventions can be checked, tuned, and reconnected to the person wearing the shoes.
From “come back if it opens” to active remission care
The 2023 International Working Group on the Diabetic Foot guideline recommends screening people at IWGDF risk 3 every 1–3 months and providing integrated foot care—professional care, adequate footwear, and structured self-care education—at similarly frequent intervals. DIATIME adds comparative randomized evidence suggesting that, for the high-risk plantar-ulcer population it studied, the four-week end of that range may be more protective than waiting eight or twelve weeks.
That has implications beyond the clinic room.
If monthly surveillance is part of effective treatment, then missed appointments, inadequate podiatry capacity, transportation barriers, rural geography, and insurance limits are not minor inconveniences. They are potential components of recurrence risk. A remission-focused system should therefore track not only whether follow-up was recommended, but whether it actually occurred on time.
It also argues for intelligent extension of care between visits: daily self-inspection, caregiver support when vision or mobility is limited, rapid-access pathways for pre-ulcerative changes, therapeutic footwear used indoors as well as outdoors, and home monitoring where appropriate. Technology should shorten the distance to skilled care, not create the illusion that skilled care is no longer needed.
The important caveat
The new paper is a narrative review, not a meta-analysis designed to establish one universal visit interval. Its underlying studies differed in population, intervention, follow-up, and definition of recurrence. The 4-versus-8-versus-12-week comparison comes from a single-center trial in high-risk patients with previously healed plantar ulcers. We still need replication, cost-effectiveness analyses, and practical studies across different health systems and risk phenotypes.
So the message is not that every person with diabetes needs monthly podiatry forever. The message is that follow-up frequency should be treated as a clinical decision—not a leftover space on the calendar.
Closure is an event. Remission is a program. And in that program, the next appointment may be part of the treatment.
References
- Miranda C, Velardi V, Da Ros R. Residual Recurrence Risk in Diabetic Foot Ulcer Remission: A Narrative Review. Diabetology. 2026;7(8):157. doi:10.3390/diabetology7080157.
- López-Moral M, García-Madrid M, García-Morales E, et al. Comparison of 4, 8, and 12 week screening and foot care frequencies in persons in remission: The DIATIME comparative efficacy study—A randomized clinical trial. Diabetes Research and Clinical Practice. 2025;230:112962. doi:10.1016/j.diabres.2025.112962.
- Bus SA, Sacco ICN, Monteiro-Soares M, et al. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes/Metabolism Research and Reviews. 2024;40:e3651.
- Armstrong DG. What Is the Optimal Follow-Up Interval After Diabetic Foot Ulcer Healing in Remission? DF Blog. 28 October 2025.
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