Legs & Feet
Leg and Foot Examination
Note: All people with diabetes should be subject to an annual foot examination to assess risk of ulceration and to ensure appropriate and timely referral.
How to do it
When to review the foot
On diagnosis of Type 2 & Type 1 diabetes and at annual review thereafter.Examination of the foot should include:
Note: Following foot assessment ensure you classify foot risk and record in patient notes.
Foot risk categorisation
Record foot risk category in patient notes as follows:
- Low current risk (normal sensation and palpable pulses)
- Increased risk (impaired sensory nerve function or absent pulses, or other risk factor)
- High risk (impaired sensory nerve function and absent pulses or deformity or skin changes, or previous ulcer)
- Ulcer present
Foot referral guidance Refer to Multi-disciplinary foot team if:
Low risk
Give self care feet advice and literature Refer to Community Podiatry Refer to Community Podiatry Ulcerated or acute foot
Sign/symptoms of ischaemia,
Urgent co-referral to vascular servicesRefer urgently to Multidisciplinary foot team, Diabetes Centre No overt problems refer to community NHS podiatrist if:
- clinically significant peripheral arterial disease (co-refer to vascular services)
- Ischaemic rest pain (co-refer to vascular services)
- Painful neuropathy
- Pain of unknown origin
- Hot red or swollen foot unknown origin
- Ulcer
- 10gram filament negative at two out of five sites tested on each foot.
- One or more absent pulses
- Foot deformity
- Presence of callus
The Bath, Wiltshire & N Somerset Diabetes Team policy is to also use this guideline for Type1 Diabetes
