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Diabetic foot problem – risk assessment

Diabetic foot risk assessment neuropathy limb ischaemia ulceration callus infection & or inflammation deformity gangrene charcot arthropathy

Use ABPI and interpret results with caution as calcified arteries may falsely elevate results


Risk stratification – current risk of developing a diabetic foot problems or needing an amputation

Low risk No risk factors other than callus alone , Continue annual foot assessments & appropriate advice


Moderate risk – deformity OR neuropathy OR non critical limb ischaemia, High risk previous ulceration OR previous amputation PR on renal replacement therapy OR neuropathy & non-critical limb ischaemia together OR neuropathy in combination with callus and / or deformity OR non critical limb ischaemia in combination with callus and / or deformity.


Refer foot protection service high risk -assessment within 2-4 weeks moderate risk – assessment within 6-8 weeks


Active foot problems – ulceration OR spreading infection OR critical limb ischaemia OR gangrene OR suspicion of an acute Charcot arthropathy or an unexplained hot , red , swollen foot with or without infection , Refer immediately to acute services
NICE gives further guidance on when to refer immediately Limb threatening or life -threatening diabetic foot problem including
- ulceration with fever or signs of sepsis
- ulceration with limb ischaemia
- clinical concern that there is a deep seated soft tissue or bone infection ( with or without ulceration )
-gangrene ( with or without ul

All other active diabetic foot problems – refer within 1 working day for triage within 1 further working dayceration )

REFERENCE Recommendations | Diabetic foot problems: prevention and management | Guidance | NICE


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