Diabetic foot Management Foot self-care education Provide general preventive foot self-care education to all patients with diabetes, including patients with loss of protective sensation, on appropriate ways to examine their feet (palpation or visual inspection with an unbreakable mirror) for daily surveillance of early foot problems. B Therapeutic footwear ADA Q Does the patient have severe diabetic neuropathy? Q Does the patient have foot deformities? Q Does the patient have foot ulcers? Q Does the patient have callous formation? Q Does the patient have poor peripheral circulation? Q Does the patient have a history of amputation? Yes to any Offer specialized therapeutic footwear in high-risk patients with diabetes, including patients with loss of protective sensation, foot deformities, ulcers, callous formation, poor peripheral circulation, and a history of amputation. B No to all Indications for specialist referral Q Does the patient smoke? Q Does the patient have a history of lower-extremity complications? Q Does the patient have loss of protective sensation? Q Does the patient have structural foot abnormalities? Q Does the patient have peripheral vascular disease? No to all Continue management and follow-up as clinically appropriate. Yes to any Refer smoker patients or patients with a history of prior lower extremity complications, loss of protective sensation, structural abnormality, or peripheral arterial disease to foot care specialists for ongoing preventive care and life-long surveillance. B