Measurement Properties of Instruments Used to Assess Diabetic Foot: An Umbrella Review

Diabetic foot is a severe, chronic complication that contributes substantially to morbidity and mortality. Numerous instruments have been developed to support systematic foot evaluation; however, their measurement properties have not been sufficiently evaluated. This umbrella review is aimed to synthesize evidence from systematic reviews on diabetic foot assessment tools, evaluate their methodological quality, and compare the psychometric properties and clinical applicability of the identified tools.

A systematic search of PubMed, EMBASE, the Cochrane Library, CINAHL, and Web of Science databases identified reviews published between 2010 and 2025. Two reviewers independently screened the studies, extracted data, and assessed methodological quality using the risk of bias in systematic reviews (ROBIS) and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) tools.

Eleven systematic reviews encompassing 24 instruments were analyzed. The ROBIS appraisal rated most reviews (73%) as having a high risk of bias. The instruments were grouped into four categories with frequent overlaps: screening, risk stratification, wound classification, and infection/healing monitoring. Evidence of reliability and construct validity was common, whereas measurement errors, responsiveness, and cross-cultural validation were rarely assessed. Heterogeneity and methodological weaknesses limit robust conclusions.

This umbrella review highlights the substantial gaps in the psychometric evaluation of assessment tools for diabetic foot, compounded by methodological flaws in supporting systematic reviews. Clinicians should exercise caution in tool selection, and future research should prioritize rigorous validation studies and high-quality systematic reviews to establish standardized evidence-based instruments.