Diabetic foot ulcers (DFUs) are a severe complication associated with diabetes, a precursor for amputation, and a major cause of patient suffering and high health-care costs.1,2 While the continuous efforts of multidisci-plinary foot clinics and preventive activities in primary care have reduced the incidence of major lower limb amputations in most countries, the prevention of DFUs remains a major challenge.3- 5 Over the years several risk factors associated with the development of a DFU have been discovered, but despite this, little is known about the factors leading directly to the first ever ulceration.6 Therefore, the predictive power of even seasoned cli-nicians in our experience remains low, and combined with the poorly reported, but relatively low, incidence of first ever DFUs, the possibilities for primary prevention is extremely limited.7 These challenges have led to re-current DFUs being studied far more than the first ever DFUs, but despite continuous improvements in healing … read more