How should I approach the management of a patient with diabetic foot ulcers in a primary care setting?

Assess and document the size, depth, and position of the diabetic foot ulcer using a standardised system such as SINBAD or the University of Texas classification system ¹.

Offer standard care treatments including offloading, control of foot infection, control of ischaemia, wound debridement, and appropriate wound dressings ¹.

Use non-removable casting to offload plantar neuropathic, non-ischaemic, uninfected forefoot and midfoot ulcers, or an alternative device until casting can be provided ¹.

Consider negative pressure wound therapy after surgical debridement, on advice from the multidisciplinary foot care service ¹.

When deciding on dressings and offloading, consider the clinical assessment, patient preferences, and use the lowest-cost appropriate devices and dressings ¹.

Refer limb-threatening or life-threatening diabetic foot problems immediately to acute services and inform the multidisciplinary foot care service for urgent assessment and treatment planning ¹.

For other active diabetic foot problems, refer the patient within 1 working day to the multidisciplinary foot care service or foot protection service for triage within 1 further working day ¹.

Provide patient education about foot care, signs of infection, foot emergencies, and footwear advice, emphasizing the importance of blood glucose control ¹.