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Proper diabetic foot care is a structured clinical process essential for limb preservation in patients with diabetes. Diabetic neuropathy, microvascular disease, and biomechanical or anatomical abnormalities increase the risk of ulceration, infection, and amputation. Neuropathic changes reduce protective sensation. Microvascular compromise impairs tissue perfusion. Musculoskeletal deformities such as hammertoes, claw toes, and ankle equinus elevate plantar pressures. Collectively, these factors contribute to tissue breakdown in the diabetic foot. Proper care includes a comprehensive dermatological, vascular, neurological, and musculoskeletal assessment; early detection and treatment of preulcerative lesions; protective and offloading footwear; and patient and family education. Care is indicated for all patients with diabetes, particularly those with previous ulceration, deformities, or peripheral arterial disease. Inadequate management substantially increases the risk of ulceration, infection, and limb loss. Interprofessional collaboration ensures comprehensive monitoring, education, and timely intervention for high-risk patients. This activity for healthcare professionals is designed to advance learners' proficiency in evaluating the diabetic foot, recognizing risk factors, and applying preventive strategies. Participants will gain deeper insights into identifying high-risk patients, assessing musculoskeletal, vascular, and dermatological changes, and implementing effective preventive and therapeutic interventions. Mastery of these competencies will enable clinicians to coordinate care effectively with interprofessional teams, ensuring early detection, prevention, and management of diabetic foot complications. Objectives: Assess the diabetic foot for risk factors for complications, including ulceration and infection, as well as structural abnormalities and early signs of tissue breakdown. Implement evidence-based diabetic foot care using appropriate equipment, trained personnel, patient preparation, and standardized techniques. Develop evidence-based individualized care plans for preventing diabetic foot complications. Collaborate with the interprofessional team to educate, treat, and monitor patients with diabetes to optimize foot health and reduce the risk of limb loss. Access free multiple choice questions on this topic.

Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia. About 589 million adults aged 20 to 79 years are living with diabetes globally as of 2025, and diabetes-related deaths are estimated at approximately 3 to 4 million annually.[1] (Source: International Diabetes Foundation, 2025) Individuals with diabetes are at increased risk of pedal ulceration due to microvascular, neuropathic, and biomechanical alterations in the foot. Neuropathy reduces pedal sensation, predisposing the foot to pressure- and trauma-related injuries. Microvascular dysfunction impairs blood flow to the lower extremities, delaying wound healing. Hemoglobin A1c (HbA1c) indicates mean blood glucose over 2 to 3 months. Both the American Diabetes Association (ADA) and the International Expert Committee recommend an HbA1c of 6.5% or greater for diabetes diagnosis.[2] Each 1% increase in HbA1c increases peripheral vascular disease risk by 25% to 28%.[3] Patients with diabetes face an elevated risk of lower extremity amputation, increased healthcare costs, and reduced quality of life. In a systematic review of nontraumatic amputations among patients with diabetes and peripheral vascular disease, the 5-year mortality rate after below-the-knee amputation was 40% to 82%, and 40% to 90% following above-the-knee amputation.[4] Many complications are preventable through annual foot examination and routine patient-performed foot care. This activity delves into the anatomy, indications, equipment, personnel, preparation, technique, complications, and clinical significance of diabetic foot care.

Inadequate diabetic foot care significantly increases the risk of ulceration, infection, and limb loss. Armstrong and Harkless demonstrated that noncompliant patients, specifically those who missed more than 50% of scheduled appointments within 1 year, are 54 times more likely to develop pedal ulcerations and 20 times more likely to undergo amputation compared to compliant patients.[29] One study reported that individuals with diabetes fear major lower-extremity amputation more than death, foot infection, or end-stage renal disease.[30] Another study found that amputation exerts the largest detrimental effect on quality of life compared to other diabetes-related complications, including stroke, blindness, renal failure, heart failure, and myocardial infarction.[31] Consequently, high-risk limbs require intensive monitoring and management by specialists, such as podiatrists.

Diabetic foot care requires interprofessional collaboration. Patients receiving team-based care demonstrate reduced severity of amputation, shorter hospital stays, lower mortality rates, improved ulcer healing, and enhanced quality of life.[32] Effective diabetes management is integral to foot care. Beyond routine endocrinology or diabetology oversight, group-based self-management programs improve body weight, fasting blood glucose, waist circumference, diabetic knowledge, and triglyceride levels. Monitoring responsibilities are shared among clinicians, nurses, and pharmacists, with results systematically relayed to the interprofessional team. Interprofessional interventions incorporating peer support have demonstrated superior reductions in HbA1c compared to peer-led groups.[33] Foot care nurses frequently perform assessments and provide patient education, but all team members share responsibility for training, reinforcing self-care, and preventing complications.

Intensive patient education by the nursing staff, encompassing lifestyle management, podiatric care, routine foot examinations, and callus management, reduces the incidence of diabetic foot ulcerations and lowers amputation rates in high-risk patients. Additionally, such education contributes to improved metabolic parameters, including reductions in plasma glucose, blood pressure, and high-density lipoprotein cholesterol levels.[34]

Care of the diabetic foot is an interprofessional responsibility. Holstein et al reported a 75% reduction in major limb amputations in patients with diabetes following the establishment of an interprofessional foot clinic with increased revascularization rates.[35] Primary care physicians and nursing staff play a key role in identifying at-risk feet and providing education on proper care and monitoring. Individuals with elevated risk factors or pedal deformities should receive regular follow-up with podiatry. Development of ulcerations necessitates more frequent surveillance and may require referral to additional specialists, including vascular surgery, infectious disease, plastic surgery, and prosthetics.