Individuals with diabetes have increased risk of neuropathy and peripheral arterial disease (PAD), and more so when other associated risk factors (eg, smoking, hypertension and hypercholesterolemia) are present (Scottish Intercollegiate Guidelines Network [SIGN] 2010). Neuropathy and PAD are the main risk factors for development of ulcers, infection and lower limb amputation (Best Practice Advocacy Centre New Zealand 2010). However, neuropathy potentially is the leading risk factor for ulceration or amputation predominately because of unnoticed foot damage (Clayton et al 2009). It is important for individuals and health care professionals to be aware of the silent nature of neuropathy as more than 60% of ulcers are preceded by an episode of unnoticed foot damage or trauma (Clayton et al 2009). If PAD is also present, the risk of infection and amputation increases (American Diabetes Association 2003). Māori and Pacific Island people have higher risk of foot ulcer development progressing to lower limb amputation as type 2 diabetes in these populations occurs 10–20 years earlier than in other populations (Grech et al nd). Foot ulcers affect a person’s physical, emotional, and social wellbeing. As a result, these issues contribute to economic loss creating a huge public health burden (Rice et al 2014). Foot screening is effective for identification of risk for foot ulceration and complications (SIGN 2010).
