Key Practice Recommendations

These key learning points summarize the consensus- and evidence-based recommendations included in this edition. The sources listed here for each statement recommend that physicians perform or implement these actions directly in a clinical setting. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the Strength of Recommendation Taxonomy (SORT) evidence rating system, go to https://www.aafp.org/afpsort.

1. Perform routine foot examinations on patients with diabetes, with frequency determined by risk factors, to identify worsening neuropathy, preulcerative conditions, and diabetic foot ulcers.
Evidence rating: SORT A
Source: Section One, references 5, 10, 12, and 13

2. Use the SINBAD classification in the primary care setting to describe newly identified diabetic ulcers when referring patients to specialists.
Evidence rating: SORT C
Source: Section One, references 3 and 15

3. Implement offloading of the diabetic foot ulcer at the time of diagnosis to reduce mechanical stress to the wound area and prevent tissue deterioration.
Evidence rating: SORT A
Source: Section One, reference 3

4. Use topical antifungals as first-line therapy to treat uncomplicated tinea pedis.
Evidence rating: SORT A
Source: Section Two, reference 1

5. Treat plantar warts with first-line therapies such as topical salicylic acid or cryotherapy.
Evidence rating: SORT B
Source: Section Two, references 25 and 27

6. Assess patients’ feet by observing gait, foot to leg alignment, and range of motion of the first metatarsophalangeal joint; examining the bare feet during weight-bearing and non–weight-bearing; and evaluating vascular, neurologic, dermatologic, and musculoskeletal components.
Evidence rating: SORT A
Source: Section Three, references 5 and 8

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