Diabetes Foot Risk Assessment
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
A diabetes foot risk assessment is a structured check of your feet if you have diabetes. It looks at how well you can feel, how well blood reaches your feet, and the shape of your feet. It also takes into account any past foot sore or amputation. The aim is to find problems early, before a wound forms. You end up with a risk category, which decides how often your feet are checked and what care you need. Everyone with diabetes should have their feet checked at least once a year.
What is it?
A diabetes foot risk assessment (also called foot screening) is a check of your feet for changes that could raise your chance of a foot ulcer (an open sore). Over time, an ulcer can lead to amputation. The check is quick, and it is one of the most important parts of looking after your health with diabetes.
It looks mainly at three things:
- Feeling. Diabetes can damage the nerves in your feet (neuropathy). If you lose protective sensation, you may not feel a cut, blister or pressure spot, so it can get worse without you noticing.
- Blood flow. Diabetes can narrow the arteries in your legs and feet (peripheral artery disease). Poor blood flow makes wounds slower to heal.
- Foot shape. Changes in the shape of your feet or toes can cause rubbing and pressure.
Your past history also counts. If you have had a foot ulcer or an amputation before, that is part of your risk.
The result is a risk category. It guides your care and how often you are checked again.
Why is it done?
The aim is to find problems early, before a wound forms. Most foot ulcers in people with diabetes are linked to nerve damage, poor blood flow or foot shape changes. Finding these early gives you and your health team time to act.
The check is good at finding the people at highest risk of an ulcer. It isn't yet clear whether a check on its own prevents limb loss. Prevention programs that combine several steps, such as regular checks, foot care education and suitable footwear, can lower the number of foot ulcers. That is why the check always leads to a plan, not just a result.
Who needs it, and how often?
Everyone with diabetes needs a foot check at least once a year. If your risk is higher, you need one more often.
How often depends on your risk category. In the Australian guideline, the repeat checks are:
- Very low risk (IWGDF risk 0): once a year.
- IWGDF risk 1: every 6 to 12 months.
- IWGDF risk 2: every 3 to 6 months.
- IWGDF risk 3: every 1 to 3 months.
Some local services set different timing. For example, some check people at low risk every two years instead of every year. Ask your podiatrist or GP what applies where you live.
If you have had a foot ulcer or an amputation, you are checked more often. How much more often isn't set exactly. A recently healed ulcer probably needs closer review than one you had many years ago.
Some hospitals also check your feet when you are admitted. Some health advice suggests a foot check at every health care visit if you have changes in foot shape, loss of feeling, peripheral artery disease, or past ulcers or amputation.
This page mostly describes checks for adults. If you are looking for advice for a child, or during pregnancy, ask your diabetes health team what suits.
What happens?
The check is done by a trained health professional. This may be your podiatrist, GP or a diabetes educator. It usually follows the same steps each time.
1. Shoes and socks off. You take off your shoes and socks so your feet can be seen properly.
2. A close look. Your clinician looks for any sores, breaks in the skin, and changes in the shape of your feet. They may also look at your skin and nails.
3. A test of feeling. The usual test uses a monofilament, a thin, flexible filament that bends at a set pressure (10 g). It is pressed lightly on parts of your feet, and you say when you feel it. Clear instructions help the test work well, so ask if you aren't sure what to do. If no monofilament is available, your clinician may use a simple touch test that needs no equipment, such as the Ipswich Touch Test or the touch-the-toes test.
4. A check of blood flow. Your clinician feels the pulses on the top of your foot and at the inside of your ankle. They also look for skin and nail changes and may compare the temperature of your feet. A hand-held Doppler (a small device that lets the clinician hear blood flow) can help, but the check can be done without one.
5. Your risk category and advice. Your clinician puts the findings together, tells you your risk category and explains what happens next.
What do the results mean?
Your result is a risk category. It is worked out from how many risk factors you have: nerve damage, poor blood flow, foot shape changes, a past ulcer and a past amputation. These five appear in almost all risk systems.
The categories used in Australia are very low risk (IWGDF risk 0), then risk 1, 2 and 3 as risk rises. Some local services use other names, such as low, moderate and high risk. Your clinician will tell you which system they use.
If you have had an ulcer, an amputation or a Charcot foot, you are in the in remission group. This means you have a very high risk of another foot ulcer or amputation, even when your feet look healthy on the day. A healthy-looking foot doesn't make you low risk.
The tests are better at confirming a problem than ruling one out. They can miss early nerve damage or narrowed arteries, so a normal result doesn't mean there is no risk. Your clinician looks at your history, your feet, your pulses and the test results together, and that is why a single test isn't relied on.
What happens next?
Your plan is matched to your category. It includes your next check date, so write it down or ask for a reminder.
- Foot care education. This should suit you, including your culture, how you like to learn (for example by seeing, hearing or reading) and your understanding of health information. Ask for it in the form that works for you.
- Footwear. Your podiatrist or another trained professional can fit shoes that protect your feet.
- Regular review. If your risk is higher, you will see your podiatrist regularly. People in the in remission group need ongoing regular review.
- Blood flow. If there are early signs of poor blood flow, the first steps are to stop smoking and keep walking. If you haven't been seen for this, you may be sent back to your GP.
Between checks, look at your feet every day. Don't wait for your next appointment if something changes. The signs to act on are listed in the next section.
When to see a podiatrist
Book an appointment if
You haven't had a foot check in the past year, or you are due for one under your risk category. Book too if you would like help with your footwear or foot care, or you aren't sure when your next check is due.
Seek prompt assessment if
you notice any of the signs below. Pain is not a reliable warning sign, because nerve damage can hide problems, so don't wait for pain.
- Call your local emergency number if your leg, foot or toes suddenly turn cold and pale or blue, with pain or numbness, or if you suddenly can't move your leg or foot. Also call if part of your foot turns black, if you have a deep infection with purple skin or a lot of pus, or if you have a foot wound or infection and also feel very unwell, with a fever or a fast heartbeat. If you also have confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine, this could be sepsis: call your local emergency number.
- See your GP or another doctor today if your foot is hot, swollen and red, or if you have a new sore, blister or wound, new swelling, or a new colour change (redder, bluer, paler or darker) on any part of your foot. Also go today if the skin on your foot becomes red, warm or painful, if redness spreads up your foot or leg, if you have a painful lump of pus, a deep sore, or pain in your foot or leg even when you are resting. If your GP can't see you today, go to an urgent care clinic or an after-hours GP.
- See your podiatrist or GP soon if you have a cut, blister or bruise on your foot that hasn't started to heal after a few days.
Frequently asked questions
What should I check on my feet every day?
Look at your feet every day, or ask a partner or carer to help. Check for any break in the skin, fluid coming from a sore, colour change or redness, new swelling and new pain. If you see any of these, get help straight away rather than waiting for your next appointment.
Can I treat corns, hard skin or blisters myself?
No. Don't burst blisters or try to remove hard skin or corns yourself. With reduced feeling, it is easy to cause an injury without noticing. See your podiatrist instead.
Why might my podiatrist do extra tests on my blood flow?
The ankle-brachial index compares blood pressure at your ankle and arm. Hardening of the artery walls (calcification) can make it less accurate. A normal result doesn't rule out poor blood flow, so your podiatrist may also do a toe pressure test. That test is less likely to be affected by calcification.
Do I need special equipment to have my feet checked?
Not much. A monofilament is the usual tool for testing feeling, and the touch tests need no equipment. A hand-held Doppler can help with blood flow, but the check can be done without one. What matters most is that a trained person does it carefully.