Synopsis
Stratify diabetic foot risk, recognise limb- and life-threatening disease, coordinate multidisciplinary ulcer care, and avoid diagnostic or antibiotic shortcuts that delay healing.
- Every diabetes foot review should inspect skin, nails, callus, deformity and footwear, test protective sensation and assess arterial supply in both feet.
- Risk rises with neuropathy, PAD, deformity, callus, previous ulcer or amputation and renal replacement therapy; follow-up intensity follows the highest feature.
- Active problems include ulceration, infection, ischaemia, gangrene and suspected acute Charcot arthropathy and require rapid foot-service referral rather than annual review.
Key red flags
Rest pain, pallor, coolness, absent pulses, delayed capillary refill, toe necrosis or a punched-out margin suggests PAD and requires urgent vascular assessment.
Investigation priorities
Define wound severity, neuropathy, deformity, skin threat and arterial supply at the bedside.
Management branches
A person with diabetes attends routine review without a current active foot problem.
- Inspect both feet and footwear, test protective sensation, assess pulses and identify deformity, callus, previous ulcer or amputation and renal replacement therapy.
- Assign the NICE risk category, explain it in practical language and refer to foot-protection services at the required interval rather than recording risk without action.
Key medicines
Flucloxacillin for mild diabetic foot infectionGive immediate-release flucloxacillin 500 mg to 1 g orally four times daily for 7 days; clinical assessment may justify up to a further 7 days, with microbiology-guided narrowing when available.
Clarithromycin when flucloxacillin is unsuitableGive clarithromycin 500 mg orally twice daily for 7 days for mild infection; clinical assessment may justify up to a further 7 days, guided by microbiology when available.