Purpose: Diabetic foot ulcers (DFU) cause major morbidity and precede most non-traumatic lower-limb amputations. Pentoxifylline, a methylxanthine haemorheological agent that improves microcirculatory flow and modulates inflammation, has established benefit in venous leg ulcer healing, but its role in DFU is undefined. The only prior systematic review pooled pentoxifylline with unrelated adjuncts (Elraiyah et al., 2016). We systematically reviewed the evidence for pentoxifylline on DFU healing and limb outcomes. Methods: MEDLINE (Ovid), the Cochrane Library, PubMed, Web of Science and Scopus were searched. Studies of oral pentoxifylline versus standard care or placebo in adults with DFU were eligible. Pre-specified outcomes were complete healing, healing time, ulcer-size reduction, quality of life and time to minor and major amputation. Results: Of 197 records, after removal of duplicate and non-English studies, three met inclusion criteria. Two assessed ulcer healing: One controlled trial (n=40) reported higher complete healing at eight weeks with pentoxifylline versus conventional care alone (16/20 [80%] vs 10/20 [50%]), with fewer amputation level procedures (Ramani et al., 1993). One other non-randomised comparative study (n=67) reported greater slough reduction and improved perfusion at 30 days (Rewale et al., 2014). A third (Al-Nimer at al., 2019) randomised trial (n=80) reported improved quality of life but did not assess healing. No study reported healing time, ulcer-size reduction or amputation as poolable or time to event data. Given few studies and heterogeneous outcome definitions, meta-analysis was not undertaken; all studies were small, single-centre and at moderate to high risk of bias. Conclusion: Evidence for pentoxifylline in DFU healing is limited. Studies to date are low quality, showing an uncertain benefit of pentoxifylline in DFU. Adequately powered randomised trials reporting healing and limb-salvage outcomes are needed.