Skip to main content

Evidence to Improve Care

Diabetic Foot Ulcers

Care for Patients in All Settings

Click below to see a list of brief quality statements and scroll down for more information.​​


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence.

See below for the quality statements and click for more detail.​


Quality Statement 1: Risk Assessment
People with diabetes are assessed for their risk of developing a diabetic foot ulcer when they are diagnosed with diabetes and at least once a year thereafter. Patients at higher risk are assessed more frequently. All risk assessments are performed using standard, validated tools.


Quality Statement 2: Patient Education and Self-Management
People with diabetes and their families or caregivers are offered education about diabetic foot care and complications, including basic foot care; how to prevent foot complications and monitor for the signs and symptoms of foot complications; and who to contact in the event of a concerning change.


Quality Statement 3: Referral to an Interprofessional Team
le with a diabetic foot ulcer are referred to an interprofessional team that delivers ongoing, coordinated, integrated care. If they have major complications, they are seen within 24 hours by a team that delivers emergency services and then referred to an interprofessional team for ongoing care.


Quality Statement 4: Comprehensive Assessment
People with a diabetic foot ulcer or foot complications undergo a comprehensive assessment that informs their individualized care plan and includes evaluation of vascular status, the presence of infection, and pressure redistribution to determine the healing potential of the wound.


Quality Statement 5: Individualized Care Plan
People with a diabetic foot ulcer or foot complications have a mutually agreed-upon individualized care plan that identifies patient-centred concerns and is reviewed and updated regularly.


Quality Statement 6: Pressure Redistribution
People with a diabetic foot ulcer or foot complications are offered pressure-redistribution devices as part of their individualized care plan.


Quality Statement 7: Wound Debridement
People with a diabetic foot ulcer have their wound debrided if it is determined as necessary in their assessment, and if it is not contraindicated. Debridement is carried out by a trained health care professional using an appropriate method.


Quality Statement 8: Local Infection Management
People with a diabetic foot ulcer and a local infection receive appropriate treatment, including antimicrobial and non-antimicrobial interventions.


Quality Statement 9: Deep/Surrounding Tissue Infection or Systemic Infection Management
People with a diabetic foot ulcer and a suspected deep/surrounding tissue infection or systemic infection receive urgent assessment (within 24 hours of initiation of care) and systemic antimicrobial treatment.


Quality Statement 10: Wound Moisture Management
People with a diabetic foot ulcer receive wound care that maintains the appropriate moisture balance or moisture reduction in the wound bed.


Quality Statement 11: Health Care Provider Training and Education
People who have developed or are at risk of developing a diabetic foot ulcer or foot complications receive care from health care providers with training and education in the assessment and management of diabetic foot ulcers and foot complications.


Quality Statement 12: Transitions in Care
People with a diabetic foot ulcer or foot complications who transition between care settings have a team or provider who is accountable for coordination and communication to ensure the effective transfer of information related to their care.

6

Pressure Redistribution

People with a diabetic foot ulcer or foot complications are offered pressure-redistribution devices as part of their individualized care plan.


A key component of treating diabetic foot ulcers and preventing recurrence is reducing pressure on the foot, which can be achieved by pressure redistribution and offloading. There are many options for redistributing pressure on the feet, from therapeutic footwear and orthotic devices (which can be beneficial in preventing recurrent ulcerations), to total contact casts (which have shown to be an effective treatment for diabetic foot ulcers).

For Patients

As part of your care plan, you should be offered ways to take pressure off your foot so it can heal, and to prevent future ulcers, too. These methods could include a non-removable cast, a cast walker, or special shoes.


For Clinicians

Offer pressure-redistribution devices to people with a diabetic foot ulcer or foot complications, to treat and heal an existing diabetic foot ulcer or to prevent recurrent ulceration.


For Health Services

Ensure access to pressure-redistribution devices for people with a diabetic foot ulcer or foot complications, to treat and heal an existing diabetic foot ulcer or to prevent recurrent ulceration.

Process Indicators

Percentage of people with a diabetic foot ulcer or foot complications who are offered pressure-redistribution devices

  • Denominator: number of people with a diabetic foot ulcer or foot complications

  • Numerator: number of people in the denominator who are offered pressure-redistribution devices

  • Data source: local data collection


Percentage of people with a diabetic foot ulcer or foot complications who use pressure-redistribution devices

  • Denominator: number of people with a diabetic foot ulcer or foot complications

  • Numerator: number of people in the denominator who use pressure-redistribution devices

  • Data source: local data collection


Percentage of people who have had a diabetic foot ulcer in the past who use pressure-redistribution devices

  • Denominator: number of people who have had a diabetic foot ulcer in the past

  • Numerator: number of people in the denominator who use pressure-redistribution devices (e.g., custom therapeutic footwear and orthotic devices)

  • Data source: local data collection

Foot complications

These include factors that may lead to soft-tissue breakdown and ulceration, such as dry skin, callus, blister, deformities, minor fractures, and subacute Charcot arthropathy.


Pressure-redistribution devices

These devices should be prescribed and fitted or applied by a regulated health care professional at the point of care. The type of device used depends on the person’s needs (prevention of recurrence or treatment) and should be based on the comprehensive assessment.

  • Prevention of recurrence:
    • Custom therapeutic footwear and orthotic devices (for those with previous ulcers or amputations)
  • Treatment:
    • Total contact casting (in the absence of infection and peripheral arterial disease; for forefoot and midfoot ulcers)
    • Removable cast walker (which can also be made irremovable) as an alternative to a total contact cast (for those who require frequent dressing changes, or for whom an irremovable device cannot be tolerated), wheelchair, or crutches

Let’s make our health system healthier

Join Our Patient, Family and Public Advisors Program

Patients, families and the public are central to improving health quality.


Claude Lurette and Kowsiya Vijayartnam, Health Quality Ontario Patient, Family and Caregiver Advisors Council Co-Chairs

Sign up for our newsletter

Are you passionate about quality health care for all Ontarians? Stay in-the-know about the newest programs, reports and news from Health Quality Ontario and sign up for our electronic newsletter.

Health Quality Connect - Health Quality Ontario's newsletter - on an iPad and a cell phone