Introduction: We evaluated the performance of muscle perfusion scan (MPS) to assess muscle perfusion reserve (MPR) for prediction of incident diabetic foot ulcerations (DFU). Methods: We recruited 41 diabetic patients without any history of DFU. Five mCi Tc-99m-MIBI was injected intravenously during repetitive dorsal and plantar right foot flexions. Then posterior calves were imaged and the counts of the region of interests (ROI) over the right and left calves were collected. MPR was calculated as the percentage of counts of right calf ROI-counts of left calf ROI / counts of left calf ROI. Six patients did not complete the study, 3 of them due to technical errors. Patients were followed for possible occurrence of DFU for at least 12 months. Results: During the 563 +/- 84 (range: 309-633) days follow up period, 2 patients developed DFU (5.7%). MPR was insignificantly lower in patients who developed foot ulceration in comparison to those without foot ulceration (11.3 +/- 0.6 % vs. 63.4 +/- 40.8 %; p=0.08). The cutoff at first decile of MPR values (i.e. 16%) discriminated the patients with and without future DFU with accuracy of 92% (OR=3; p-Value=0.005). Conclusion: MPS is useful to detect patients with diabetes at risk for future DFU.