This document systematically reviews literature on footwear prescription for ulcer prevention and reduction in diabetic patients. It found 6 randomized controlled trials examining footwear and insole interventions to offload the diabetic foot. Factors influencing plantar pressures included footwear/insole design and compliance. In-shoe pressure analysis was effective for selecting target regions for offloading and modifying footwear. Further high-quality clinical trials are needed to inform how footwear design aspects affect diabetic populations.