Perform a comprehensive foot examination and provide foot self-care education annually on patients with diabetes to identify risk factors predictive of ulcers and amputations.

The foot examination can be accomplished in a primary care setting and should include the use of a monofilament, tuning fork, palpation, and a visual examination.

A multidisciplinary approach is recommended for individuals with foot ulcers and high-risk feet, especially those with a history of prior ulcer or amputation.

Refer patients who smoke or with prior lower-extremity complications to foot care specialists for ongoing preventive care and life-long surveillance.

Initial screening for peripheral arterial disease (PAD) should include a history for claudication and an assessment of the pedal pulses. Consider obtaining an ankle-brachial index (ABI), as many patients with PAD are asymptomatic.

Refer patients with significant claudication or a positive ABI for further vascular assessment and consider exercise, medications, and surgical options.