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Improving diabetes footcare

Up to 80% cent of people with diabetes die within five years of having an amputation or a foot ulcer. Evidence shows that providing an integrated footcare pathway, with trained staff in foot protection services in the community and speedy access to multidisciplinary specialist teams, considerably lowers the risk of amputation.

Use the following resources and tools to improve footcare for people with diabetes.


Improving diabetic footcare: a guide for commissioners, The College of Podiatry, Public Health England (2017)

This online guide supports CCGs in England to commission improved services for diabetic foot disease. It provides information on the impact of diabetic ulcers and amputations on patients' lives and on NHS costs, and what good care looks like and how to commission it. It also includes case studies and interviews with commissioners and clinicians from around the country who have transformed their services.

Footcare economic study cover

Improving footcare for people with diabetes and saving money: an economic study in England, Insight Health Economics for Diabetes UK (January 2017) (PDF, 59KB)


This summary report presents new estimates of the costs of diabetes-related amputations and foot ulcers in England. It also updates estimates of the numbers of people with diabetes experiencing foot ulcers and examines the potential to improve care and reduce costs. Download the full report (PDF, 1.3MB).



How to: use root cause analysis to reduce diabetes related amputations, Diabetes UK (June 2016) (PDF, 205KB)


This guide provides practical, step-by-step information on how to complete root cause analysis (RCA). It includes who to involve, how to gather the right data, and techniques to help identify root causes. Download the tools and templates featured in the guide.


Adapting the Ipswich Touch Test to increase foot risk assessments at the Royal Free Hospital, Diabetes UK (August 2016) (PDF, 363KB)

This bright idea describes how the Royal Free Hospital created a foot risk assessment tool based on the Ipswich Touch Test. Since introduction of the tool, the percentage of people with diabetes who received a foot risk assessment on admission increased from 6.5 per cent in 2013 to 40 per cent in 2015. Download the tool featured in the bright idea (PDF, 42KB).

Fixing footcare in Sheffield: improving the pathway, Diabetes UK (February 2015) (PDF, 258KB)

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This case study describes how the diabetes team at Sheffield Teaching Hospitals NHS Foundation Trust significantly reduced their amputation rates by introducing some simple, proven quality improvement approaches.

Integrated footcare pathway, Diabetes UK (May 2017) (PDF, 435 KB)

Integrated Footcare Pathway


This resource provides information for commissioning and planning an integrated footcare pathway and includes a patient risk stratification and triage tool.

Putting feet first: six step guide to improving diabetes footcare, Diabetes UK (June 2017) (PDF, 668KB)

Putting feet first: six step guide to improving diabetes footcare


This resource outlines the six steps CCGs can take to improve footcare and reduce amputations in their local area.

Essential reading

Shared practice examples



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