©2017 by Insight Health Improvement Ltd

Make Change Happen

Six Vital Steps

Protocols and pathways

Clear pathways are essential for rapid access to appropriate care.


All those involved in caring for people with diabetes, including GPs and practice nurses, need to know about the services that are in place, referral criteria and how to ensure rapid access.​NICE guidelines set out how to examine the feet of a person with diabetes, how to assess risk, and when to refer to the foot protection service or MDFS.

People at low risk of developing a diabetic foot problem should have annual foot assessments, should be told about the importance of foot care, and should be advised that they could progress to moderate or high risk. 

People at moderate or high risk should be referred to the foot protection service.

The foot protection service should assess people who are at high risk within 2-4 weeks, and those at moderate risk within 6-8 weeks. 

Reassessments should be carried out:

  • Annually for people who are at low risk

  • Frequently (for example, every 3–6 months) for people who are at moderate risk

  • More frequently (for example, every 1–2 months) for people who are at high risk, if there is no immediate concern

  • Very frequently (for example, every 1–2 weeks) for people who are at high risk, if there is immediate concern. 

 

More frequent reassessments should be considered for people who are at moderate or high risk, and for people who are unable to check their own feet. 

People with limb-threatening or life-threatening diabetic foot problems such as soft tissue or bone infection, gangrene, ulcer with sepsis or fever, ulcer with limb iscahemia, should be referred immediately to acute services and the multidisciplinary foot care service should be informed, according to local protocols and pathways.

For all other active diabetic foot problems, people should be referred within 1 working day to the multidisciplinary foot care service or foot protection service according to local protocols and pathways for triage within 1 further working day. 

Local protocols should set out the relationship between the foot protection service and the multidisciplinary foot care service, and ensure that people receive the right expert assessment and care within the timescales set out by NICE.