[8] Where wounds take a long time to heal, infection may set in, spreading to bones and joints, and lower limb amputation may be necessary.

Patients would be taught routinely to inspect their feet for hyperkeratosis, fungal infection, skin lesions and foot deformities.

Control of footwear is also important as repeated trauma from tight shoes can be a triggering factor,[10] especially where peripheral neuropathy is present.

[11] Foot screening guidelines have been previously reviewed, with a view to examining their completeness in terms of advancement in clinical practice, improvements in technology, and changes in socio-cultural structure.

It concluded that for the development of standard recommendations and everyday clinical practice, it was necessary to pay more attention to both the limitations of guidelines and the underlying evidence.

[12] According to a 2011 meta-analysis of randomised controlled trials, only foot temperature-guided avoidance therapy was found beneficial in preventing ulceration.

[16] A simpler method proposed by researchers provides a more detailed risk score based on three pieces of information (insensitivity, foot pulse, previous history of ulcers or amputation).

[18] Treatment of diabetic foot ulceration can be challenging and prolonged; it may include orthopaedic appliances, surgery and antimicrobial drugs and topical dressings.