Last reviewed: 20 Dec 2021
Last updated: 29 Oct 2021



History and exam

Key diagnostic factors

  • presence of risk factors
  • foot ulcer
  • foot pain
  • loss of protective sensation
  • foot deformity
  • fever or chills

Other diagnostic factors

  • malaise
  • anorexia
  • foot erythema
  • oedema of foot, ankle, or calf
  • absent pedal pulses
  • fluctuance

Risk factors

  • previous history of foot ulcer
  • previous history of amputation
  • sensory neuropathy
  • peripheral arterial disease
  • end-stage renal disease
  • Charcot midfoot deformity
  • structural forefoot deformities
  • limited ankle joint mobility (ankle equinus)
  • visual impairment
  • poor glycaemic control

Diagnostic investigations

Investigations to consider

  • microbiological culture
  • erythrocyte sedimentation rate
  • C-reactive protein
  • ankle/toe pressures
  • renal function
  • angiography
  • MR angiography
  • CT angiography
  • MRI foot
  • arterial duplex ultrasound

Emerging tests

  • serum procalcitonin
  • 18F-fluorodeoxyglucose (FDG)-PET/CT

Treatment algorithm



Frances L. Game, MBBCh, FRCPath

Consultant Diabetologist and Clinical Director of R&D

Department of Diabetes and Endocrinology

University Hospitals of Derby and Burton NHS Foundation Trust




FLG declares that she has no competing interests.


Dr Frances L. Game would like to gratefully acknowledge Dr Neal R. Barshes, Dr Joseph L. Mills, and Dr David G. Armstrong, previous contributors to this topic.


NRB and DGA declare that they have no competing interests. JLM is a consultant for, and owns stocks in, Nangio TX; a member of the scientific advisory committees for Cesca, AnGes, and AstraZeneca; and the Co-National Principal Investigator for the Voyager trial of rivaroxaban in peripheral arterial disease patients undergoing intervention (funding for this institutional research grant goes directly to the Baylor College of Medicine).

Peer reviewers

Simon Ashwell, MBChB, MD, FRCP

Consultant Physician of Diabetes and Endocrinology

Diabetes Care Centre

The James Cook University Hospital




SA declares that he has no competing interests.

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