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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.

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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.


People with a diabetic foot ulcer benefit from individualized care by health care professionals who have comprehensive training and education in diabetic foot ulcers and how to assess and manage them. Training and education materials or programs are additional to entry-level programs and should be tailored to providers’ roles and responsibilities and the type of care they provide. This may range from screening and referral to the provision of ongoing wound care, pressure-redistribution devices, and working with an interprofessional team to conduct comprehensive assessments and interventional procedures.

For Patients

You should receive care from a team of health care professionals who have been trained to care for people with diabetic foot ulcers or foot complications.


For Clinicians

Ensure that you have the training and education required to effectively provide care (including assessments, strategies for prevention, and treatments) for people who have developed or are at risk of developing a diabetic foot ulcer or foot complications, in accordance with your professional role.


For Health Services

Ensure that health care providers caring for people who have developed or are at risk of developing a diabetic foot ulcer or foot complications have training and education in how to carry out comprehensive assessments and provide appropriate treatments, including local wound care and pressure-redistribution devices.

Structural Indicator

Local availability of providers trained in the assessment and management of diabetic foot ulcers and foot complications

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.


Provider training and education

These should include the following skills and information, at a minimum:

  • Risk assessment (Quality Statement 1), comprehensive assessment (Quality Statement 4), and individualized care planning (Quality Statement 5)

  • Techniques for providing effective patient education (Quality Statement 2)

  • Local wound care, including debridement (Quality Statement 7), infection management (Quality Statements 8 and 9), and wound moisture management (Quality Statement 10)

  • Pressure-redistribution devices (Quality Statement 6)

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