Patients with neuropathy should be referred to podiatry for preventative foot care if they are assessed to be at moderate or high risk of developing a diabetic foot problem. Criteria for referral include:
- Presence of peripheral sensory neuropathy causing loss of sensation in the feet.
- Presence of foot deformities, such as those resulting from previous Charcot arthropathy, which increase ulceration risk.
- Any signs of active diabetic foot problems such as ulceration, infection, chronic limb-threatening ischaemia, gangrene, or suspicion of acute Charcot arthropathy.
- Patients at moderate risk should be referred to the foot protection service for assessment within 6 to 8 weeks, and those at high risk within 2 to 4 weeks.
The foot protection service, led by podiatrists with specialist training, will provide skin and nail care advice, biomechanical assessment including specialist footwear needs, and vascular status assessment. Reassessment frequency depends on risk level, ranging from annual for low risk to very frequent (1 to 2 weeks) for high risk with immediate concerns.
Therefore, neuropathy alone warrants referral if it places the patient in moderate or high risk categories for diabetic foot problems, to enable preventative care and reduce risk of ulceration and complications.
References: NICE NG19