Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Practice Recommendations

1.0 Physical examination of the feet to assess risk factors for foot ulceration/amputation should be performed by a health care professional.
      1.1 This examination should be performed at least annually in all people with diabetes over the age of 15 and at more frequent intervals for those at higher risk.

2.0  Nurses should conduct a foot risk assessment for clients with known diabetes.
This risk assessment includes the following:

  • History of previous foot ulcers;
  • Sensation;
  • Structural and biomechanical abnormalities;
  • Circulation; and
  • Self-care behaviour and knowledge.

3.0 Based on assessment of risk factors, clients should be classified as “lower” or “higher” risk for foot ulceration/amputation.

4.0 All people with diabetes should receive basic foot care education.
      4.3 Foot care education should be provided to all clients with diabetes and reinforced at least annually.

5.0 Nurses in all practice settings should provide or reinforce basic foot care education, as appropriate.
      5.3 The basic foot care education for people with diabetes should include the following six elements:

  • Awareness of personal risk factors;
  • Importance of at least annual inspection of feet by a health care professional;
  • Daily self inspection of feet;
  • Proper nail and skin care;
  • Injury prevention; and
  • When to seek help or specialized referral.

      5.4 Education should be tailored to client’s current knowledge, individual needs, and risk factors. Principles of adult learning must be used.

6.0 Individuals assessed as being at “higher risk” for foot ulcer/amputation should be advised of their risk status and referred to their primary care provider for additional assessment or to specialized diabetes or foot care treatment and education teams as appropriate.