Diabetic Foot Australia guideline
Photo credit: Provided by the Authors
critical review and expert opinion feedback.
The authors of this guideline, all (inter)national
experts in the field of diabetic foot ulcer
and footwear management, came from the
following backgrounds: podiatric medicine
(n = 5), podiatric surgery (n = 1), human
movement science (n = 2), wound medicine
(n = 2), pedorthics (n = 1), rehabilitation
medicine (n = 1), endocrinology (n = 1),
and vascular surgery (n = 1). A third draft
incorporating feedback from all co-authors
was written by the first author (JvN) and
again sent to all co-authors for review. This
process was repeated one more time, until
consensus was reached from all authors,
leading to the final version of the guideline,
approved by all authors.
Definitions for foot risk status
The purchase and wearing of appropriate
footwear is an important process of care
for all individuals with diabetes. This
importance increases as the individual’s
risk for developing a foot ulcer increases.
Different classifications for foot risk status
are used worldwide. For the purpose of this
Australian footwear guideline we followed
the classification provided in the Australian
NHMRC guideline [31] :
(i) Low-risk of foot ulceration: people with
no identifiable risk factors on foot screening
(no peripheral neuropathy, peripheral artery
disease, foot deformity, previous foot ulcer,
or history of lower-extremity amputation).
(ii) Intermediate-risk of foot ulceration:
people with only one risk factor on foot
screening (either peripheral neuropathy,
peripheral artery disease or foot deformity)
and no previous foot ulcer or amputation.
(iii) High-risk of foot ulceration: people with
two or three risk factors on foot screening
(peripheral neuropathy, peripheral artery
disease or foot deformity) or with a previous
foot ulcer or amputation.
According to the NHMRC guideline, Aboriginal
and Torres Strait Islander people with
diabetes are considered to be at high-risk for
foot ulceration, until the person’s level of risk is
adequately assessed and confirmed otherwise
[31]
.
To determine foot risk status, all people with
diabetes should undergo at least a yearly
foot screening by an appropriately trained
registered healthcare professional with
demonstrated competency [14, 31] . People with
an intermediate- or high-risk foot status
should be screened at least once every 3 to 6
months [14, 31] . In accordance with the NHMRC
guideline, this should consist of screening for
peripheral neuropathy (10 g monofilament
sensitivity; vibration perception; neuropathy
disability score), peripheral artery disease
(palpation of peripheral pulses; ankle-brachial
pressure index; toe-brachial pressure index),
foot deformity (six point scale scoring small
muscle wasting, Charcot foot deformity,
bony prominence, prominent metatarsal
head, hammer or claw toes and limited joint
mobility), and assessment of a history of foot
ulcer(s) or lower-extremity amputation [31] .
The Australian Diabetes Society has published
a video-example of such a foot examination
(Fig.1) [35] .
Structure of the guideline
This guideline consists of three parts
and a discussion. Firstly, footwear
recommendations and their rationale
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