Foot complications remain one of the most serious and costly consequences of diabetes in the UK. National guidance consistently shows that early identification of risk, regular foot screening, and timely referral are critical in preventing ulceration, infection, or even amputation.

This guide outlines the current UK podiatry diabetes guidelines, explaining how diabetic foot risk is assessed, when referral is required and the role podiatry plays in prevention and long-term management.

People with diabetes are at increased risk of foot problems due to a combination of peripheral neuropathy, reduced blood flow to the lower limbs, changes in foot structure and biomechanics, and a reduced ability to heal or fight infection. These changes often develop gradually and without obvious symptoms, meaning issues may go unnoticed until significant damage has occurred.

Without early intervention, these changes can progress to more serious diabetic foot complications, including ulceration, infection, and amputation.

Foot ulceration is relatively common and is associated with serious consequences, including infection, hospital admission, and amputation. UK audit data has repeatedly shown that delays in assessment and referral are linked to poorer outcomes, reinforcing the importance of structured, podiatry-led care pathways.

Although local care pathways vary, UK guidance is broadly aligned around a small number of shared aims. These include early identification of foot risk, prevention of ulceration, rapid access to specialist care for active foot problems, and long-term reduction in avoidable amputations.

Risk stratification is used to guide review frequency and management. While terminology will vary slightly, UK podiatry diabetes guidelines generally describe the following risk groups. Accurate classification relies on structured screening and clear documentation as part of a wider diabetes foot risk assessment. 

Low Risk

Where protective sensation and circulation are intact, and there is no history of foot disease.

Moderate Risk

Where a single risk factore is present, such as loss of protective sensation or signs of perhipheral arterial disease.

High Risk

Where multiple risk factors exist, or where significant deformity is present.

Remission

Referring to people with previous ulceration, amputation or healed Charcot arthropathy.

Active Foot Disease

Including current ulceration, infection or suspected Charcot foot.

Risk status should be reviewed regularly and updated when clinical circumstances change.

Routine diabetic foot screening may be carried out by podiatrists or other appropriately trained healthcare professionals. Screening typically involves visual inspection of the feet, assessment of skin integrity and callus, neurological testing to assess protective sensation, and vascular assessment where indicated. Foot shape, pressure areas, and footwear suitability are also considered.

Where vascular compromise is suspected, objective assessment using ankle and toe pressure measurement can support clinical decision-making, with tools such as the Huntleigh Ankle and Toe Pressure Kit commonly used in diabetic foot assessment. 

Neurological assessment commonly includes the use of a 10 g monofilament to assess protective sensation. Further details on correct technique are covered in our guide to monofilament testing. The findings from screening inform both risk classification and ongoing management planning.

UK podiatry diabetes guidelines are clear that any person with diabetes who presents with a new active foot problem requires urgent assessment.

Immeadiate referral is required for:

• Ulceration with signs of infection or sepsis
• Limb-threatening ischaemia
• Suspected deep soft tissue or bone infection
• Gangrene or rapidly deteriorating foot conditions 

Urgent referral (usually within one working day) is required for:

• New foot ulcers without systemic illness
• Suspected Charcot arthropathy
• Worsening lesions in people at high risk

Early referral to a specialist or multidisciplinary foot services is one of the most important factors in reducing amputation risk and improving healing outcomes.

Management is guided by foot risk status and whether active disease is present. UK podiatry guidelines emphasis early intervention, appropriate escalation and multidisciplinary care.

For people at low risk, management focuses on routine screening, preventative advice and education. maintaining skin integrity is an important part of prevention, and the use of products formulated for diabetic skin such as Akildia Multi Protective Cream for Diabetic Feet, may support routine care.

Those at moderate or high risk usually require ongoing podiatry input, with management centred on monitoring, pressure reduction, and early identification of skin breakdown. In some cases, insoles designed to improve pressure distribution such as Vasyli Maximum Contact Pro Insoles, may be recommended.

People with previous ulceration or amputation require long term follow up, as the risk of recurrence remains high even after the foot has healed.

Where active foot disease is present, treatment should be delivered through a multidisciplinary foot care service to reduce the risk of progression and amputation. 

Education is a consistent theme across UK podiatry diabetes guidelines. Patients should be supported to inspect thier feet regularly, recognise early signs of change, wear appropriate footwear, and seek advice promptly if problems arise.

Clear consistent messaging helps patients engage with preventative care and reduces delays in presentation.

Following UK podiatry guidelines supports early identification of foot risk, timely escalation of active foot disease, and consistent standards of care. For podiatry clinics and wider healthcare teams, clear screening processes, defined referral pathways, and access to appropriate tools and training remain essential in delivering safe and effective diabetic foot care. 

These principles underpin NICE guidance, NHS diabetic foot pathways and national audit reccomendations.