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Foot health information leaflets for people with diabetes

Christian Pankhurst, Martin Fox, Duncan Stang

Throughout the four nations of the UK, the need for a coordinated approach to diabetes foot care and the delivery of the complex provision for such services has been widely recognised. Documents such as the Scottish Intercollegiate Guidelines Network (SIGN, 2017) and National Institute for Clinical Excellence (NICE, 2016) guidelines on foot care for people with diabetes have been developed to provide information for preventing and managing foot problems in children, young people and adults with diabetes and aim to reduce variation in practice.

These guidelines were developed and written by representatives of all members of the multidisciplinary team, including people with diabetes, for:

  • Healthcare professionals that care for people with diabetes
  • Commissioners and providers of diabetes foot care services
  • People with diabetes, and their families and carers.

Recent updates to these guidelines have included clarification of the risk factors for and stratification around the risk of developing a foot problem in diabetes, with recommendations on: care or advice within 1 working day; care across all care settings; referral for diabetic foot problems; investigating and managing diabetic foot ulceration, diabetic foot infection and Charcot arthropathy.

The development of these documents, together with the Diabetes Foot Risk Stratification and Triage tools, have gone a long way to providing the basis of a reduction in variation to the approach to diabetes foot screening together with recommendations of the next steps required once a person’s risk level has been determined.

To complement the foot risk screening algorithm, healthcare professionals within FDUK (Foot in Diabetes UK) and the Scottish Diabetes Foot Action Group (SDFAG) recognised the need to ensure that information being provided to people with diabetes was standardised in order to reduce variation, regardless of location or the level of experience and profession of the health care professional performing he foot screening.

In respect to the updates to the national guidelines, a thorough and lengthy review of the shared foot care information leaflets for people with diabetes commenced in the summer of 2017, which included consultation with people with diabetes, podiatrists, consultants, diabetes specialist nurses and orthotists. It was recognised that the previous information leaflets (produced by the Scottish Diabetes Foot Action Group in 2008) for people with diabetes regarding foot care, did not include information relating to associated cardiovascular risk, nor did they accurately or clearly convey what people with diabetes were actually at risk of. When these leaflets were being reviewed, all available material was gathered together with expert opinions to perform a full critique and appraisal in order to allow a full evaluation of information included and revision to occur.

Following an extensive consultation period, new, updated information leaflets which are deemed to be more fit for purpose have been produced. These were developed with the mindset of ‘informing to empower, not scare’ themes, in order to support people with diabetes to help protect their lives and limbs. As with the previous generation, these leaflets are risk targeted and colour coordinated to complement the foot screening and stratification systems, with ‘Low Risk’ printed in green, ‘Moderate Risk’ in amber and the ‘High Risk’ and ‘In Remission’ leaflets in red. Other leaflets include: ‘Looking after your diabetic foot ulcer’, ‘Holiday feet’, ‘Advice about your footwear’ and ‘Charcot foot’. All of these leaflets state what people with diabetes are at modifiable risk of from the front cover, with anecdotal advice removed.

Each leaflet includes information about cardiovascular risks and effective measures to reduce these risks, allowing for open and honest conversations about the risks of avoidable amputation and premature death. Information boxes have been included, directing people to the signs and symptoms of a potential ‘foot attack’ and instructions to follow. For those with an active foot ulceration, information regarding monitoring of their overall health and wound is included as an ‘early warning system’ in order to guide people to seek urgent and immediate medical attention if any new danger signs are experienced.

The leaflets are designed to help clinicians and patients to have sometimes difficult conversations about life- and limb-threatening aspects of diabetes-related foot disease, in an open and transparent way, as recommended by bodies such as NICE. This will help ensure that people with diabetes have clear, consistent written and verbal information, which can help inform and optimise their health choices, to support amputation-free survival, at all stages of diabetes and lower-limb disease.

After review and consultation with nationally recognised bodies, these leaf lets have been endorsed by the following organisations: The Association of Clinical Diabetologists, the British Association Prosthetists and Orthotists, The College of Podiatry, Diabetes UK, Diabetes Inpatient Specialist Nursing UK Group, The Foot in Diabetes UK, Diabetic Foot Network Wales, NHS Scotland, the Primary Care Diabetes Society, the Royal College of Nursing, the Scottish Diabetes Foot Action Group and the Welsh Diabetes Endocrine Society (logos in the margin opposite). Following this stratification, the leaf lets were reviewed by the Plain English Campaign, gaining the Crystal Mark for clarity.

Work is currently under way for these updated leaf lets to be translated into the most common five non-English languages spoken in the UK and they will be available shortly. The English versions of these leaflets are currently available to download from the College of Podiatry’s website and the Diabetes in Scotland websites.


NICE (2016) Diabetic Foot Problems: Prevention and Management: NICE Guideline [NG19]. Available at: (accessed 16.10.2018)

SIGN (2017) Management of Diabetes 116. A National Clinical Guideline. Avilable at: (accessed 16.10.2018)

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