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Practice Guidelines

Inpatient management of diabetic foot problems: summary of NICE guidance

BMJ 2011; 342 doi: (Published 23 March 2011) Cite this as: BMJ 2011;342:d1280
  1. T Tan, technical analyst1,
  2. E J Shaw, technical adviser1,
  3. F Siddiqui, assistant technical analyst1,
  4. P Kandaswamy, technical analyst, health economics1,
  5. P W Barry, consultant in paediatric intensive care2, honorary senior lecturer3,
  6. M Baker, consultant clinical adviser1
  7. on behalf of the Guideline Development Group
  1. 1Centre for Clinical Practice, National Institute for Health and Clinical Excellence, Manchester M1 4BD, UK
  2. 2University Hospitals of Leicester NHS Trust, Leicester LE5 4QF, UK
  3. 3Department of Child Health, University of Leicester, Leicester LE1 6TP
  1. Correspondence to: P W Barry pwb1{at}

Foot problems that are related to diabetes (“diabetic foot” problems) affect a substantial number of people with diabetes, and 15% of people with diabetes will have a foot ulcer at some point in their lives. Diabetic foot ulcers precede more than 80% of amputations in people with diabetes and are the most common cause of non-traumatic limb amputation in the United Kingdom. Delays in diagnosis and management of diabetic foot problems increase morbidity and mortality, contribute to a higher amputation rate,1 and seriously affect patients’ quality of life—for example, by reducing mobility, leading to loss of employment, depression, and damage to or loss of limbs. Diabetic foot problems have a financial impact on the NHS through increased outpatient costs and bed occupancy and prolonged stays in hospital.

This article summarises the most recent recommendations in a short clinical guideline from the National Institute for Health and Clinical Excellence (NICE) on the management of diabetic foot problems in inpatients.2


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Multidisciplinary foot care team

  • Each hospital should have a care pathway for patients with diabetic foot problems who need inpatient care. This care pathway is for people with diabetes who have (a) an ulcer, blister, or break in the skin of the foot; (b) inflammation or swelling of any part of the foot or any sign of infection; (c) unexplained pain in the foot; (d) fracture or dislocation in the foot, with no preceding history of substantial trauma; or (e) gangrene of all or part of the foot.3 The multidisciplinary foot care team …

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