Practice Guidelines

Society for Vascular Surgery Releases Guideline on Managing the Diabetic Foot


Am Fam Physician. 2016 Nov 15;94(10):834-835.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Those with diabetes mellitus should have an annual foot evaluation using the Semmes-Weinstein monofilament test to assess for peripheral neuropathy.

• A total contact cast or irremovable fixed ankle walking boot should be used for offloading in patients with plantar diabetic foot ulcers.

• Magnetic resonance imaging is recommended when more sensitive or specific imaging is needed, particularly if soft tissue abscess is suspected or the diagnosis of osteomyelitis is uncertain after standard imaging.

• Patients with diabetic foot ulcers and concomitant peripheral arterial disease should be referred to a vascular subspecialist to be assessed for revascularization.

From the AFP Editors

The diabetic foot is a key area of morbidity associated with diabetes mellitus. The Society for Vascular Surgery collaborated with the American Podiatric Medical Association and the Society for Vascular Medicine to create evidence-based guidelines to improve the care of patients with a diabetic foot. Although there is limited high-quality evidence, the guidelines use the best available evidence and consider patient preference and clinical context. The authors used the Grades of Recommendation Assessment, Development, and Evaluation system to rate the evidence, which identified stronger recommendations for which the benefits outweigh the risks and weaker recommendations for which the ratio of benefits to risks is dependent on the clinical scenario.

Prevention of Diabetic Foot Ulcers


Patients with diabetes should have an annual foot evaluation performed by a physician or clinician with training in foot care. The evaluation should include the Semmes-Weinstein monofilament test to assess for peripheral neuropathy. Patients and families should be educated about preventative foot care. Custom therapeutic footwear is recommended for high-risk patients, such as those with significant neuropathy, foot deformities, or previous amputations. Prophylactic arterial revascularization is not recommended for preventing diabetic foot ulcers.


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Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of Practice Guidelines published in AFP is available at



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