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Practice Clinical updates

Diabetic foot

BMJ 2017; 359 doi: (Published 16 November 2017) Cite this as: BMJ 2017;359:j5064
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Click here for a visual overview of the primary care assessment and monitoring of a diabetic foot

  1. Satish Chandra Mishra, consultant surgeon and scientist1,
  2. Kunal C Chhatbar, consultant surgeon2,
  3. Aditi Kashikar, research assistant3,
  4. Abha Mehndiratta, technical adviser4
  1. 1Department of Surgery, Bhabha Atomic Research Centre Hospital, Mumbai, India
  2. 2KHM Hospital, Mumbai, India
  3. 3Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
  4. 4Global Health and Development Group, Imperial College London, St Mary’s Hospital, London, UK
  1. Correspondence to: A Mehndiratta abha{at}

What you need to know

  • Diabetic foot can be prevented with good glycaemic control, regular foot assessment, appropriate footwear, patient education, and early referral for pre-ulcerative lesions

  • Examine the feet of people with diabetes for any lesions and screen for peripheral neuropathy and peripheral arterial disease, which can lead to injuries or ulceration

  • Refer patients with foot ulceration and signs of infection, sepsis, or ischaemia immediately to a specialised diabetic foot centre for surgical care, revascularisation, and rehabilitation

Foot disease affects nearly 6% of people with diabetes1 and includes infection, ulceration, or destruction of tissues of the foot.2 It can impair patients’ quality of life and affect social participation and livelihood.3 Between 0.03% and 1.5% of patients with diabetic foot require an amputation.4 Most amputations start with ulcers and can be prevented with good foot care and screening to assess the risk for foot complications.5 We provide an update on the prevention and initial management of diabetic foot in primary care.

Sources and selection criteria

This clinical update is based on recommendations in the standard treatment guideline, The diabetic foot: prevention and management in India 2016, published by the Indian Ministry of Health and Family Welfare.33 A multidisciplinary guideline development group consisting of surgeons, primary care practitioners, and a patient representative developed these guidelines, with inputs from experts in diabetes, diabetic foot rehabilitation, and vascular surgery. The group included representation from rural and urban India, and public and private sectors.

The guideline development group selected recommendations from the National Institute for Health and Care Excellence clinical guideline 19. Diabetic foot problems: prevention and management. Updated 2016, International Working Group on the Diabetic Foot guidance on the prevention of foot ulcers in at-risk patients with diabetes 2015, National Institute for Health and Care Excellence. Peripheral arterial disease: diagnosis and management. Guideline 147, 2012, and …

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