Diabetes foot check

What is a diabetes foot check, and what is it for?

A diabetes foot check (the clinical name is diabetes foot risk assessment, also called foot screening) looks for signs that diabetes is changing your feet in ways that could lead to a foot ulcer (an open sore) and, through that, amputation¹. The aim is to find problems early, before a wound forms².

It focuses on nerve damage (which can dull your feeling), poor circulation (peripheral artery disease) and changes in foot shape. It also takes in any past ulcer or amputation³. The clinician then uses what they find to judge your risk of an ulcer and place you in a risk category⁴.

Who needs a diabetes foot check, and how often?

Everyone with diabetes should have their feet checked at least once a year by a trained health professional, such as a GP, podiatrist or diabetes educator⁵. People at very low risk are checked yearly for loss of feeling and circulation problems, and people at higher risk are checked more often⁶.

The Australian guideline repeats checks every 6–12 months for IWGDF risk 1, every 3–6 months for risk 2 and every 1–3 months for risk 3⁵. (IWGDF is the international group whose risk levels are used.) Your clinician will tell you which level you're at. Because of Australia's size, some people can't get a timely check⁵, so if yours is overdue, ask your GP what's available.

What happens during a diabetes foot check?

The check usually follows the same steps each time, with your shoes and socks off⁷.

• Looking. The clinician checks for sores and for any change in the shape of your foot⁷.
• Testing feeling. This is usually done with a monofilament (a thin, flexible filament pressed against your skin)⁷. A simple alternative is the Ipswich Touch Test, a light touch to your toes that needs no equipment⁸.
• Checking circulation. The clinician feels the pulses in your feet⁷. A hand-held Doppler (a small ultrasound device) is useful if available, but the check can be done without one⁹.
• Risk category and advice. You're told your category and given advice⁷. Foot-care education is recommended for everyone with diabetes¹⁰.

What do the results mean, and how accurate is the check?

Your category comes from the findings above: nerve damage, circulation, foot shape, and any past ulcer or amputation³. The higher your category, the more often you're checked⁵. You may also be offered education suited to you, and advice on protective footwear fitted by someone trained⁵. Category names and intervals can differ between services, so follow the plan your clinician gives you.

If you've had an ulcer, an amputation or Charcot foot (a condition affecting the bones and joints of the foot), you're in the "in remission" group. Your risk of further ulcers is very high, even when your foot looks healthy, so you need ongoing regular review¹¹. If early signs of reduced circulation are found, stopping smoking and keeping walking are the first steps, and your GP can advise⁹.

The tests are better at confirming a problem than ruling one out. A normal monofilament or Ipswich Touch Test doesn't rule out nerve damage¹²⁸, and a normal ankle-brachial index (a blood pressure comparison at the ankle) doesn't rule out artery disease¹³¹⁴. Results also depend on the clinician's technique and training¹⁵.

What are the limits of a diabetes foot check, and are there alternatives?

These checks can reliably pick out the people at highest risk of an ulcer, but it isn't clear yet whether screening itself prevents limb loss¹⁶. Because each test can miss things, clinicians combine your history, a look at your feet, sensation tests and pulses rather than relying on one result.

If an ankle-brachial index may be unreliable, for example when artery walls are stiffened by calcium, a toe-brachial index (a blood pressure check at the toe) may be less affected¹⁷. A podiatrist or foot care team can look further when the picture is unclear.

Most of this information is about adults. If the check is for a child, or you're pregnant, ask your GP or podiatrist what applies.