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Table 7 Summary of IWGDF screening suggestions for Recommendation 2*

From: Australian guideline on prevention of foot ulceration: part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease

When a person with diabetes is identified as being at-risk of foot ulceration (i.e. IWGDF risk 1 to 3):

• More extensive and more frequent foot examination is needed, as the ulcer risk is higher.

• The examination should include (but is not limited to):

 - taking a detailed history of foot ulceration, lower-extremity amputation, and determining a diagnosis of end-stage renal disease;

 - physical examination of the foot for presence of deformities or progression thereof; abundant callus and pre-ulcerative signs, such as blisters, fissures and haemorrhage; and limited joint mobility;

 - history of other factors (suggested based more on expert opinion), including social isolation, poor access to health care, financial constraints, foot pain (with walking or at rest), and numbness or claudication;

 - examining the presence of ill-fitting, inadequate, or lack of footwear, abnormal skin colour, temperature or oedema; poor foot hygiene (e.g. improperly cut toenails, unwashed feet, superficial fungal infection, or unclean socks), physical limitations that may hinder foot self-care (e.g. visual acuity, obesity); and foot care knowledge are also suggested;

• Any foot ulcer identified during screening should be treated according to the principles outlined in the suite of IWGDF Guidelines [26, 39, 41,42,43,44] and/or the Australian DFD Guidelines [40, 45,46,47,48].

  1. Note: DFD Diabetes-related foot disease, IWGDF International Working Group on the Diabetic Foot
  2. *Adapted from: Bus SA, Lavery LA, Monteiro-Soares M, Rasmussen A, Raspovic A, Sacco ICN, et al. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36(Suppl 1):e3269. Pp 4-5