Background: Diabetic foot ulcer (DFU) is a commonly reported complication of diabetes, requiring long-term clinical assessment. Socio-economic costs associated with travel and specialist examination can be difficult to manage, especially for patients who reside in rural/remote Australia. As such, there is a pressing need for more efficient avenues by which health services can be delivered to these patients. Telemedicine is an established means of using evolving telecommunication technology to obtain and disseminate medical data and services.

Objectives: The aim of this study was to review the role of telemedicine in DFU management, evaluating its diagnostic accuracy, cost-effectiveness, behavioural perceptions and impact on clinical outcomes within the context of rural/remote areas.

Method: The MEDLINE/PubMed and Google Scholar databases were systematically searched from January 1980 to April 2015. The following terms were used: “Telemedicine” OR “Telehealth”, “Diabetes” OR “Diabetic ulcer”, “leg” and “foot”. Foot ulcers had to be of diabetic origin. Telemedicine systems unable to generate visual representations of ulcers were excluded. 

Results: 948 identified studies were evaluated against the inclusion criteria. 11 eligible studies were included for review; of which 2 were conducted in Australia. Studies that evaluated telemedicine against clinical outcomes were underpowered by study design, sample sizes, and short duration follow-up. Telehealth systems demonstrated good intra- and inter-observer reproducibility, high diagnostic accuracy and agreement with live assessments. Authors rationalised cost-effectiveness of respective telehealth systems, but were unable to support views with long-term cost analysis. Both patient and health professionals responded positively towards telemedicine in surveys and face-to-face interviews.

Conclusion: Telemedicine yields high diagnostic accuracy, reproducibility and positive behavioural perceptions. However, it is not clear if telemedicine use in DFU management has favourable clinical and economic outcomes. More long-term prospective controlled trials on larger populations are needed to justify the integration of telemedicine in DFU management within rural/remote Australia.