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

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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

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)

Note: After completing a comprehensive foot exam, assign a category of risk for each patient. Categories of risk are defined as:

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 - Foot Care

Diabetes Foot Care CME/CE Training

Online CME/CE Education

Videos: Foot Exams

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.