Diabetes Standards of Care & Clinical Practice Resources
Foot Care
People who have diabetes are at high risk for nerve and vascular damage that can result in loss of protective sensation in the feet, reduced circulation, and poor healing. Foot ulcers and amputations, due to diabetic neuropathy and/or peripheral arterial disease (PAD), are common and preventable causes of disability in adults with diabetes. Since 10-20% of patients with diabetes who present for routine care will have a condition that requires prompt attention (e.g., calluses, bacterial or fungal infections, bulky or ingrown nails, or frank ulceration), it is important to inspect patients' feet at every diabetes visit.
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Foot Care Sections
Quickly jump to a section on this page by clicking on one of the links below.
- Section 1 – Clinical Practice Recommendations: Foot Care
- Section 2 – Clinician and Educator Resources: Foot Care
- Section 3 – Patient Education Resources: Foot Care
Clinical Practice Recommendations
Recommendations for Foot Care
Screening
Note: After completing a comprehensive foot exam, assign a category of risk for each patient. Categories of risk are defined as:
- Obtain history of ulceration, amputation, Charcot foot, angioplasty or vascular surgery, cigarette smoking, retinopathy, renal disease, vascular disease, and assess symptoms of neuropathy (pain, burning, numbness) and vascular disease (leg fatigue, claudication)
- At each diabetes visit, inspect patients' feet for acute problems
- At diabetes diagnosis, and at least annually, perform a comprehensive foot examination to include assessment of:
- Skin integrity
- Vascular status including pulses in the legs and feet
- Foot structure and biomechanics
- Neurological exam with a 10-g monofilament and at least one other assessment (vibration sensation using a 128-Hz tuning fork, pinprick sensation, or ankle reflexes)
- Low Risk: normal sensory exams, foot structure, vascular status, and skin integrity, and no prior non-traumatic ulcerations
- High Risk: abnormalities on exam or a history of non-traumatic ulcerations
Treatment
- Provide risk-appropriate evaluation and monitoring, and refer patients as needed to foot care specialists (podiatrists, wound care specialists), footwear providers, orthopedists, and vascular surgeons.
- Provide self-management education including proper care of the foot, nail and skin care, appropriate footwear, and daily visual inspection of the feet
Clinician and Educator Resources
Diabetes Education Lesson Plan: Keeping Your Feet Healthy [PDF – 669 KB]
Diabetes Foot Care CME/CE Training
NOTE: Access to this information is not restricted; however, the information found here is intended for use by medical providers. Some videos contain graphic images. Patients should talk with their medical providers about any specific concerns.
NOTE: Access to this information is not restricted; however, the information found here is intended for use by medical providers. Some videos contain graphic images. Patients should talk with their medical providers about any specific concerns.
NOTE: Access to this information is not restricted; however, the information found here is intended for use by medical providers. Some videos contain graphic images. Patients should talk with their medical providers about any specific concerns.
IHS Division of Diabetes Treatment and Prevention
Diagnosis and Management of Diabetic Foot Complications [PDF]
American Diabetes Association
American Diabetes Association Standards of Medical Care in Diabetes – 2020
Diabetes Care 2020;43(Supplement 1):S135-S151. doi:10.2337/dc20-S011
Comprehensive Foot Examination and Risk Assessment: A report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists
Diabetes Care 2008 Aug; 31(8): 1679-1685. doi: 10.2337/dc08-9021
Diabetic Neuropathies: The Nerve Damage of Diabetes
National Institute of Diabetes and Digestive and Kidney Diseases
Lower Extremity Amputation Prevention (LEAP)
Health Resources and Services Administration
Working Together to Manage Diabetes: A Guide for Pharmacy, Podiatry, Optometry, and Dentistry
National Diabetes Education Program
Patient Education Resources
Keeping Your Feet Healthy [PDF – 655 KB]
IHS Division of Diabetes Treatment and Prevention
National Institute of Diabetes and Digestive and Kidney Diseases
Diabetes and You: Healthy Feet Matter! [PDF]
Take Care of Your Feet for a Lifetime: A Booklet for People with Diabetes [PDF]
National Diabetes Education Program
American Diabetes Association
Diabetes Forecast