Category: The purpose of foot screening (NHS Scotland)

Following the screening process every individual should be informed of their risk category and have that risk explained to them in a way in which they understand it in accordance with the Diabetic Foot Risk Stratification and Triage Chart. Every individual should be given verbal and written information regarding their risk status in a way that they understand it and what it means for them.

It is recommended that all Low risk individuals are educated in and have a focus on self management, this can be achieved through individual or group educational programmes and the Low Risk foot leaflet. Individuals of Moderate, High/In Remission and Active foot disease will have a treatment and management plan implemented by a podiatrist where appropriate with the intention of trying to prevent primary or recurrent ulceration which should include appropriate educational updates at each visit.

It is hoped that following the appropriate risk categorisation with the subsequent introduction of a treatment/management plan agreed with the individual that this can minimize or help prevent primary or recurrent ulceration or other foot problems.

The above leaflets can be downloaded from the My Diabetes My Way, Diabetes in Scotland websites and the SCI-Diabetes foot screening page. They are also available in the 5 most common non English languages and are available for download from the Diabetes in Scotland website.

Diabetic foot risk stratification and triage

Select the crosses on the image below for more detail

These risk categories relate to the use of the SCI-Diabetes foot risk stratification tool

Diabetic foot risk stratification and triage

These risk categories relate to the use of the SCI-Diabetes foot risk stratification tool

Diabetic foot risk stratification and triage

These risk categories relate to the use of the SCI-Diabetes foot risk stratification tool

Diabetic foot risk stratification and triage

These risk categories relate to the use of the SCI-Diabetes foot risk stratification tool

Diabetic foot risk stratification and triage

These risk categories relate to the use of the SCI-Diabetes foot risk stratification tool

The process of foot screening must lead to the individual with diabetes being assigned a risk category, and informed of and understand what that risk category means to them as an individual living with diabetes. According to the assigned risk category this will result in the introduction of a treatment/management plan according to that risk level formulated in consultation with the individual with diabetes, tailored to suit their needs.

The validity of diabetic foot screening is optimized if the process is carried out and recorded in a standardised manner wherever the individual is seen. It is recommended as an area of good practice within the sign guideline that:

‘The result of a foot screening examination should be entered onto an online screening tool, such as the Scottish Care Information – Diabetes Collaboration system (SCI-DC), (now known as SCI – Diabetes), to provide automatic risk stratification and a recommended management plan, including patient information’.

Foot screening may be carried out by any health care professional/worker involved in the care of an individual with diabetes. Examples of these could include the following: podiatrist, podiatry technician, practice nurse, support worker, district nurse, General Practitioner or any other competent healthcare worker.

It is not important who undertakes the screening process as long as the individual carrying this out has the capability and training to do so and is aware of what action to take depending on the results and the individual with diabetes risk status. This capability can be gained by undertaking this training and the test at the end of this module.

The guideline simply states that:

‘All patients with diabetes should be screened to assess their risk of developing a foot ulcer’.

It also stated that:

‘There is no evidence to support the frequency of screening; however the SIGN guideline group considers that at least annual screening from the diagnosis of diabetes is appropriate’.

Following wide consultation with the Scottish Diabetes Foot Action Group it was decided to update our Traffic Light System (2016) and subsequently the way foot screening is delivered in Scotland to reflect recent evidence (Leese et al 2006), (Crawford et al 2020) and to ‘mirror’ some of the changes that have been introduced to the national Diabetes Retinal Screening (DRS) programme.

Summary of key changes to foot screening

1. Foot screening for people in the Low Risk category foot move from annual to every 2 years in keeping with clinical evidence.
2. When an individual transitions from Low Risk to Moderate Risk they should be referred to a podiatrist for assessment (which may be a one off appointment) and be provided with a tailored care package if required, which would be agreed with the individual with diabetes, to reduce the risk of ulceration. Annual foot screening maintained.
3. All individuals with diabetes deemed to be High/In Remission no longer require a foot screening as foot screening is to determine the risk an individual with diabetes has of developing a foot ulcer and they will never return to a lower risk category. The duty of care and management for all individuals with diabetes deemed to be High/In Remission will fall to podiatry services. The individual with diabetes will work in partnership with podiatry services to create a mutually agreed and documented Treatment/Management plan according to need, which will include education and advice regarding the importance of self-management, with the focus on preventing primary or recurrent ulceration. This Treatment/Management plan may also include ongoing referral to vascular, orthotics, multidisciplinary foot clinics, orthopaedics etc. where appropriate.