The IWGDF Guidelines – Navigating Diabetic Foot Care – An interview with Prof. Sicco Bus

22. February 2024

In the realm of diabetic foot care, the International Working Group on Diabetic Foot (IWGDF) stands as a beacon of guidance, offering evidence-based recommendations to clinicians worldwide. Recently, we had the privilege of conversing with Prof. Sicco Bus, a prominent figure within the IWGDF, shedding light on the genesis, collaborative process, global challenges, and the implementation of these crucial guidelines.


ALPS: Can you explain the purpose of the IWGDF guidelines and its main objectives?

Prof. Sicco Bus: Certainly. The IWGDF, or International Working Group on Diabetic Foot, aims to develop evidence-based guidelines for the prevention and management of diabetic foot disease. Our primary objective is to provide comprehensive recommendations to healthcare professionals worldwide, covering various aspects of diabetic foot care, including wound healing, infection control, vascular aspects, offloading, Charcot foot, and prevention.

Prof. Sicco Bus

“While collating, assessing and summarizing the literature (evidence) represents the most time consuming aspect of developing the guidelines, a tremendous feature of the guidelines is the ‘evidence based medicine’ approach they encompass.  Such an approach combines the best available evidence with providers’ clinical expertise and patients’ values and preferences. I think one of the key updates to the 2023 offloading guidelines is a prime example of this. The recommendation to provide a

ALPS: What prompted your involvement in diabetic foot care, and what roles do you fulfill within the IWGDF?

Prof. Sicco Bus: My journey into involvement in diabetic foot care began during my research tenure at Penn State University, where I worked with Professor Peter Cavanagh, a renowned biomechanist in the field. The multidisciplinary nature of diabetic foot disease intrigued me, aligning well with my background in human movement science and biomechanics. Since 2007 I’ve been actively involved in the IWGDF, serving as the chair of two working groups on offloading and prevention and membership of the editorial board.


ALPS: How did the IWGDF guidelines come into existence, and what needs or challenges within diabetic foot care drove their initiation?

Prof. Sicco Bus: The IWGDF guidelines originated in 1999, spurred by the growing recognition of diabetic foot disease as a multifactorial health concern. With research efforts intensifying in the 1980s and the establishment of specialized diabetic foot clinics, there arose a need for comprehensive guidelines to elevate the standard of care. These guidelines were crafted by pioneers in the field, reflecting the collaborative spirit of various disciplines involved in diabetic foot care.


ALPS: Could you describe the collaborative process involved in developing the IWGDF guidelines and how professionals from different disciplines contribute to shaping them?

Prof. Sicco Bus: Collaboration lies at the heart of IWGDF guideline development, drawing upon the expertise of diverse healthcare professionals. Working groups comprise individuals from podiatry, surgery, diabetology, wound healing, biomechanics, and other specialties, ensuring a holistic approach to guideline creation. By incorporating insights from different disciplines, we aim to address the multifaceted challenges of diabetic foot care comprehensively.


ALPS: Considering the global nature of diabetic foot care challenges, how do the IWGDF guidelines aim to address these challenges on an international scale?

Prof. Sicco Bus: The IWGDF guidelines prioritize equity and accessibility, acknowledging the diverse healthcare settings across regions. While implementation of evidence may vary geographically, our guidelines strive to accommodate these differences by offering nuanced recommendations tailored to different healthcare systems. Moreover, the translation of guidelines into multiple languages enhances accessibility, empowering healthcare professionals globally to deliver optimal diabetic foot care.


ALPS: Walk us through the process of writing and updating the IWGDF guidelines. How often are they revised, and how does the incorporation of new knowledge and technologies contribute to these updates?

Prof. Sicco Bus: The IWGDF guidelines undergo an update every four years, ensuring they remain abreast of the latest evidence and technologies in diabetic foot care. The writing process entails a systematic review of literature, followed by the integration of evidence, patient preferences, and feasibility considerations. Incorporating the GRADE methodology, these guidelines evolve iteratively, adapting to the dynamic landscape of diabetic foot care to optimize patient outcomes.


ALPS: How do you envision the implementation of IWGDF guidelines in clinical practice, and what role do conferences like DFCon play in facilitating their dissemination and collaboration among healthcare professionals?

Prof. Sicco Bus: The implementation of IWGDF guidelines poses challenges, but efforts to enhance awareness and dissemination are underway. Conferences like DFCon serve as pivotal platforms for knowledge exchange and collaboration among healthcare professionals globally. By leveraging such opportunities and employing modern communication methods, we aim to amplify the reach of our guidelines, fostering innovation and optimal patient care in diabetic foot management.


In conclusion, the IWGDF guidelines exemplify excellence in evidence-based practice, aligning perfectly with ALPS’s mission to end preventable amputations by enhancing multidisciplinary care. By transcending geographical boundaries, these guidelines play a pivotal role in advancing diabetic foot care worldwide. Through collaborative endeavors and a commitment to innovation, the IWGDF continues to lead the charge towards optimal patient outcomes in diabetic foot management. We at ALPS are delighted to actively participate in collaborating on these guidelines, ensuring that the latest clinical evidence is effectively disseminated to practitioners. Our collaboration with IWGDF underscores our shared dedication to improving diabetic foot care and reducing the incidence of amputations globally.


Learn more about the IWGDF Guidelines on this website:

For more information about this interview please contact ALPS Program Director Annkathrin Mathe at

shoe lift to the contralateral limb in an effort to improve the comfort and balance of patients using a knee-high or ankle-high offloading device keeps the focus on treating the patient and not simply treating the ulcer.”

Dr. Ryan Crews, ALPS Founding Secretary

About ALPS

The American Limb Preservation Society (ALPS) is a leading organization dedicated to advancing the prevention and management of limb-threatening conditions. ALPS fosters collaboration among healthcare professionals and advocates for research and education to improve patient outcomes.



The mission of the International Working Group on the Diabetic Foot (IWGDF) is to produce evidence-based guidelines to inform health care providers all over the world on strategies for the prevention and management of diabetic foot disease. Thus the IWGDF aims to reduce the high patient and societal burden of diabetic foot disease.

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