Perform foot examination and risk classification

Checked at new diagnosis and, if low risk, annually thereafter.

However, if increased or high risk consider more frequent assessments (such as monthly)

Provide footwear advice and who to contact in foot emergencies.

Assess the current individual risk of developing a foot problem: 

1. Low risk: normal sensation, palpable pulses

2. Increased risk: neuropathy or absent pulses

3. High risk: neuropathy or absent pulses PLUS deformity OR skin changes in previous ulcer

Serious deformities include:

Ulcerated foot

Spreading infection

Critical ischaemia and/or gangrene

Charcot arthropathy: acute localisation inflammatory leading to bone destruction, subluxation, dislocation and deformity.

Urgent (2w, 6w) referral to the foot protection service for increased/high risk classifications

Immediate referral to multidisciplinary foot care service if limb-threatening foot problem is identified