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
- Foot screening for people in the Low Risk category foot move from annual to every 2 years in keeping with clinical evidence.
- 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.
- 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.