The NICE guideline states that:
‘Children and adults with diabetes should have their risk of developing a diabetic foot problem assessed’.
There is limited evidence to support the frequency of screening; however the NICE guideline group recommends the following:
‘For adults with diabetes assess their risk of developing diabetic foot problem at the following times:
- When diabetes is diagnosed and at least annually thereafter
- If any foot problems arise
- On any admission to hospital and if there is any change in their status while they are in hospital
For children with diabetes who are under 12 years give them and their family members or carers (as appropriate) basic foot care advice.
For young people with diabetes who are 12-17 years the paediatric care team or the transitional care team should assess the young person’s feet as part of their annual assessment and provide information about foot care.’
This is the module test for ‘Diabetic Foot Screening’. It is strongly recommended that you work through the learning materials of the module prior to commencing this test. By going straight to the test you may miss out on valuable learning contained within the module. The answers to all the test questions are contained within the module.
You will be presented with 6 patient scenarios, based on the information provided for each patient you will be asked to assess whether each patient is Low, Moderate, High or Active foot Disease. You must answer all of these scenarios correctly to obtain a certificate of completion and competence. You will be asked to fill out a form adapted from the Scottish SCI-DC form, however it is not an exact representation of the form and is used purely for learning purposes.
The form is pre populated as if the patient is suffering from no problems and will only need changed if the patient is perceived to be suffering from a problem after carrying out the screening process. The only area which is not pre populated is whether the patient’s pulses are either present or both absent and this must be filled in when vascular screening has been completed.
The highlighted area on the form on the right hand side of the page will correspond to the area of the form which is being completed.
You should allow approximately 20 minutes to complete the test. You should complete this test in one session.
To gain a certificate in the Diabetes Foot Screening, select the test below. You should allow approximately 20 minutes to complete this quiz.
This certificate can be used as evidence of continual professional development (CPD).
Online competency-based tool for diabetes
DEP is a competency-based online diabetes learning tool that supports all levels of healthcare practitioners demonstrate their diabetes knowledge and skills relevant to their role. A variety of diabetes specific topics are available which currently amounts to 24 hours of diabetes study time. New content is developed on an ongoing basis and is launched once it have been rigorously tested.
CDEP is based on the UK national diabetes competency frameworks. These frameworks help structure the nature and level of diabetes skills required by all healthcare staff to support safer patient care, improved outcomes and reduce the financial burden of diabetes.
Diabetic foot screening apps
The Society of Chiropodists & Podiatrists
The College of Podiatry, in collaboration with their special advisory group Foot in Diabetes UK and the British Association of Prosthetists and Orthotists, have created two apps to enable increased knowledge around the problems that can occur in the diabetic foot. One is for health care professionals who undertake diabetic foot screenings, the other is for people with diabetes to ensure they are empowered to prevent problems with their feet. Both apps follow NICE (National Institute for Health and Care Excellence) and SIGN (Scottish Intercollegiate Guidelines Network) guidelines.
Diabetic Foot Screening app for Health Care Professionals
The app explains the risk categorisation when conducting a foot screening. Those with diabetes will be categorised as either at low, moderate or high risk of developing a foot ulcer. Full explanations are given as to what this means are given with computerised pictures of the various conditions that can affect those with diabetes.
Diabetic Foot Screening app for people with diabetes
The app for people with diabetes will explain what to expect at your annual foot screening, why this is taking place, what the Health Care Professional will do with the results, and what you should come out with and what this means. i.e. your risk category (at low, moderate or high risk of developing a foot ulcer) and verbal and written information with emergency contact details. There will also be information and video clips on footwear advice, self-care, what to look out for.
It also explains how diabetes can affect the feet. It also allows you to track foot screening appointments (offering reminders when they are due).
The app provides detailed, practical information on how to look after your feet, with video clips on footwear advice, self-care, what to look out for. It allows you to record emergency contact details for your GP, your Podiatrist, etc.
The Diabetic Foot Risk Stratification and Triage chart below has been developed from the NICE guideline [NG19]: Diabetic foot problems: prevention and management, using a format taken from the SIGN 116 guidelines. Following the foot screening process the patient should be assigned and informed of their risk category and a treatment and management plan introduced according to the chart if required.
Select the crosses on the image below for more details.
Download PDF for printing
There are 3 points tested with the monofilament on each foot:
- Plantar surface of the distal hallux
- 1st Metatarsal head
- 5th Metatarsal head
When performing the monofilament test the filament must be held at a 90° angle to the foot. Contact with the skin should last approximately between 1 and 2 seconds.
Try this out using the interactive simulation below.
Performing the monofilament test
Testing for diabetic neuropathy using a monofilament
Duration: 16 seconds, format: MP4
Demonstrating the monofilament test
Duration: 16 seconds, format: MP4