Diabetic foot disease is an important complication of diabetes mellitus which should be screen for on a regular basis. NICE produced guidelines relating to diabetic foot disease in 2015.

It occurs secondary to two main factors:

• neuropathy: resulting in loss of protective sensation (e.g. not noticing a stone in the shoe), Charcot's arthropathy, dry skin
• peripheral arterial disease: diabetes is a risk factor for both macro and microvascular ischaemia

Presentations

• neuropathy: loss of sensation
• ischaemia: absent foot pulses, reduced ankle-brachial pressure index (ABPI), intermittent claudication
• complications: calluses, ulceration, Charcot's arthropathy, cellulitis, osteomyelitis, gangrene

All patients with diabetes should be screened for diabetic foot disease on at least an annual basis

• screening for ischaemia: done by palpating for both the dorsalis pedis pulse and posterial tibial artery pulse
• screening for neuropathy: a 10 g monofilament is used on various parts of the sole of the foot

NICE recommend that we risk stratify patients:

All patients who are moderate or high risk (I.e. any problems other than simple calluses) should be followed up regularly by the local diabetic foot centre.