Recommendation 1: We recommend that patients with diabetes undergo annual interval foot inspections by physicians (MD, DO, DPM) or advanced practice providers with training in foot care (Grade 1C). See Table 1.1 for evaluation frequency based on risk profile.

Recommendation 2: We recommend that foot examination include testing for peripheral neuropathy using the Semmes-Weinstein test (Grade 1B).

The Semmes-Weinstein test is thought to be most accurate and involves a monofilament sensory stimulation at defined areas on the foot and over the first toe and first, third, and fifth metatarsal areas. The examiner elicits a yes or no response from the patient to the pressure of the filament. The recommended frequency of this test is empirical, but yearly with the primary care provider examination is reasonable.

Recommendation 3: We recommend education of the patients and their families about preventive foot care (Grade 1C).

Recommendation 4:

  1. We suggest against the routine use of specialized therapeutic footwear in average-risk diabetic patients (Grade2C).
  2. We recommend using custom therapeutic footwear in high-risk diabetic patients, including those with significant neuropathy, foot deformities, or previous amputation (Grade 1B).

Recommendation 5: We suggest adequate glycemic control (hemoglobin A1c < 7% with strategies to minimize hypoglycemia) to reduce the incidence of diabetic foot ulcers (DFUs) and infections, with subsequent risk of amputation (Grade 2B).

Recommendation 6: We recommend against prophylactic arterial revascularization to prevent DFU (Grade 1C).