What Is a Diabetic Foot Assessment — and Why Could It Save Your Life?

If you are living with diabetes, you have probably heard your doctor mention getting your feet checked. You may have nodded, made a mental note, and then moved on to the next item on your health to-do list. It is easy to deprioritise something that does not seem urgent — especially when your feet feel fine.

But here is the reality: the feet that feel fine are often the ones that need attention the most. Because with diabetes, by the time something hurts, the window for easy intervention may already be narrowing.

A diabetic foot assessment is one of the most important health appointments you can keep. This is what it involves, why it matters, and what happens after.

Why Diabetes Makes Your Feet Vulnerable

To appreciate why a foot assessment is so important, it helps to understand what diabetes does to your feet over time — often without you realising it.

Peripheral Neuropathy

Persistently elevated blood sugar levels damage the peripheral nerves — the nerves that carry sensation from your feet to your brain. This is called peripheral neuropathy, and it affects up to half of all people with long-term diabetes.

The result is a gradual loss of protective sensation. You may stop feeling pain, temperature changes, pressure, or the early warning signs of injury. A blister from a new shoe, a small cut from a stone, a developing ulcer — any of these can go unnoticed for days or weeks. By the time you see it, the damage may already be significant.

Poor Circulation

Diabetes damages blood vessels throughout the body, including those supplying the feet and lower legs. Reduced blood flow means wounds heal slowly — if at all. The immune response is impaired. Infection takes hold more easily and spreads more quickly. Tissue that cannot receive adequate oxygen and nutrients begins to break down.

The Dangerous Combination

Neuropathy and poor circulation together create a scenario where injuries you cannot feel are also injuries your body struggles to repair. This is why diabetes is the leading cause of non-traumatic lower limb amputation worldwide — and why research consistently shows that early detection and regular professional assessment can prevent up to 85% of diabetes-related amputations.

The assessment exists to find problems before they find you.

What Is a Diabetic Foot Assessment?

A diabetic foot assessment is a comprehensive clinical examination performed by a podiatrist to evaluate the neurological, vascular, structural, and skin health of your feet. It is not a basic check — it is a systematic, evidence-based review designed to identify your current level of risk and detect any early signs of complications.

Every person with diabetes should have a formal foot assessment at least once a year. Those with existing risk factors — neuropathy, circulation problems, previous ulcers, or foot deformities — may need to be reviewed more frequently.

Here is what the assessment involves.

What Happens During a Diabetic Foot Assessment?

1. Medical History and Diabetes Review

Your podiatrist will begin by taking a thorough medical history. This includes:

• How long you have had diabetes and which type
• Your current blood sugar control — including HbA1c levels if known
• Any medications you are taking
• Other health conditions, particularly cardiovascular disease, kidney disease, or high blood pressure
• Your lifestyle — activity levels, occupation, footwear habits
• Any previous foot problems, ulcers, or surgeries
• Whether you have noticed any changes in sensation, temperature, or skin appearance

This context shapes everything that follows. A person who has had diabetes for twenty years with variable blood sugar control is assessed very differently to someone newly diagnosed with well-managed levels.

2. Neurological Assessment — Testing Sensation

This component of the assessment checks for signs of peripheral neuropathy — nerve damage that reduces your ability to feel pain and pressure in your feet.

Monofilament TestingA thin, flexible nylon filament is gently pressed against specific points on the sole of your foot. You are asked to indicate whether you can feel it. The monofilament applies a standardised amount of pressure — if you cannot detect it, this signals a loss of protective sensation, which significantly increases your risk of undetected injury.

Vibration TestingA tuning fork is placed against bony prominences of the foot — typically the big toe joint and the ankle. Your ability to feel the vibration is recorded. Reduced vibration sense is an early indicator of neuropathy, often detected before other symptoms develop.

Ankle ReflexesThe tendon reflex at the ankle may be tested to assess nerve function more broadly. Absent or diminished reflexes can indicate significant neurological changes.

Temperature and Sharp/Blunt SensationIn some cases, your podiatrist will also test your ability to distinguish between temperatures or between sharp and blunt stimuli on the foot.

3. Vascular Assessment — Checking Blood Flow

This component evaluates the circulation in your feet and lower legs — a critical factor in wound healing and infection risk.

Foot PulsesYour podiatrist will manually check the pulses at two key points in each foot — the dorsalis pedis (top of the foot) and the posterior tibial (behind the ankle). Weak or absent pulses can indicate peripheral arterial disease.

Doppler UltrasoundA handheld Doppler device uses sound waves to detect and evaluate blood flow in the foot arteries. It produces an audible signal that your podiatrist interprets to assess the quality of circulation. This is a quick, painless, and highly informative test.

Capillary Refill TimeYour podiatrist will press briefly on a toenail or the skin of your foot and observe how quickly the colour returns. Delayed capillary refill indicates sluggish circulation.

Skin Temperature and ColourThe colour, temperature, and texture of your skin provide important visual clues about circulation. Cold, pale, or bluish skin may indicate reduced blood flow. Abnormal warmth or redness may signal inflammation or infection.

Ankle-Brachial Pressure Index (ABPI)In some cases, your podiatrist may arrange or refer for an ABPI measurement — a comparison of blood pressure at the ankle and the arm — which gives a more precise indication of arterial blood flow and peripheral arterial disease severity.

4. Skin and Nail Assessment

A detailed visual and physical examination of the skin and nails covers:

• Dry or cracked skin — particularly on the heels, which can split and create entry points for infection
• Calluses and corns — thickened skin from pressure that, in diabetic feet, can break down into ulcers underneath
• Any wounds, blisters, or ulcers — including their size, depth, location, and signs of infection
• Fungal nail infections — thickened, discoloured nails that are harder to manage and can harbour bacteria
• Ingrown toenails — a seemingly minor issue that carries significant infection risk in diabetic patients
• Skin infections — including athlete's foot, which can create cracks allowing bacteria to enter

Any finding in this area is documented carefully, as even seemingly minor changes carry greater significance in the context of diabetes.

5. Structural and Biomechanical Assessment

The shape of your foot and the way it functions affect where pressure falls with every step. Areas of abnormal pressure are at higher risk of callus formation and ulceration.

Your podiatrist will assess:

• Foot posture — flat feet, high arches, and foot deformities such as bunions or hammer toes
• Areas of abnormal pressure or load distribution
• Joint flexibility and range of motion
• Whether any structural changes are placing particular areas of the foot at risk

Pressure mapping technology may be used in some clinics to provide a detailed visualisation of how your foot loads during walking.

6. Footwear Assessment

Ill-fitting footwear is one of the most common causes of diabetic foot ulceration — and one of the most preventable. Your podiatrist will examine your current footwear and assess:

• Whether shoes provide adequate width and depth in the toe box
• The condition of the inner lining — worn areas, seams, or debris that could cause friction
• Whether shoes provide sufficient support and cushioning
• Whether your footwear is appropriate for your level of risk and foot shape

Guidance on appropriate footwear is a key part of the assessment outcome, and in some cases, referral for custom diabetic footwear or orthotics may be recommended.

Risk Stratification: What Happens After the Assessment

Once all findings are gathered, your podiatrist will assign a risk category — typically low, moderate, or high — based on the results of each component of the assessment.

Low RiskNo significant neuropathy, adequate circulation, no deformity or previous ulceration. Annual review recommended, with education on daily self-care.

Moderate RiskOne or more risk factors present — neuropathy, circulation changes, or foot deformity — but no active problem or history of ulceration. More frequent monitoring, typically every three to six months, with targeted preventative care.

High RiskSignificant neuropathy, poor circulation, previous ulceration, or major foot deformity. Frequent review — often every one to three months — with active preventative care, custom footwear, and close monitoring.

Active Foot ProblemAny open wound, ulcer, or signs of infection represent an active problem requiring urgent intervention, often involving a multidisciplinary team including your GP, an endocrinologist, and potentially a vascular surgeon or wound care specialist.

This risk stratification is not a label — it is a clinical tool that determines the frequency and intensity of your ongoing care. And crucially, risk categories can change. Early intervention can reduce risk. Poorly managed blood sugar and neglected foot care can increase it.

What You Can Do Between Assessments

A once-yearly professional assessment is essential — but the daily choices you make between appointments matter just as much.

• Inspect your feet every morning for any changes in skin, nails, or sensation
• Wash feet in lukewarm water, dry thoroughly — especially between the toes
• Moisturise daily with a urea-based cream, avoiding the spaces between toes
• Never walk barefoot, even indoors
• Wear well-fitting, protective footwear and check inside shoes before putting them on
• Cut nails straight across and see a podiatrist for anything you are unsure about
• Never attempt to treat corns, calluses, or wounds yourself with over-the-counter products
• Report any changes — redness, swelling, warmth, wounds, or numbness — to your podiatrist or GP promptly

When to Seek Urgent Care

Do not wait for your next scheduled appointment if you notice:

• Any open wound or ulcer on the foot, no matter how small
• Redness, swelling, or warmth — with or without pain
• A dark or black area on a toe or the foot
• Discharge or unusual odour from the foot
• Fever alongside any foot concern
• A sudden change in foot colour, shape, or temperature

These are red flags requiring same-day assessment. In the context of diabetes, what appears minor can deteriorate rapidly.

The Bottom Line

A diabetic foot assessment is not a formality. It is a potentially life-altering appointment that can detect the early signs of nerve damage and poor circulation before they lead to wounds, infections, and the complications that follow.

Every person living with diabetes deserves regular, thorough professional foot care. Not because something is wrong — but because identifying what might go wrong, before it does, is always better than responding after the fact.

The assessment takes less than an hour. The protection it provides can last a lifetime.

Living with diabetes? Book your diabetic foot assessment with our podiatry team online or call (03) 8358 9929. Early care is always better than late intervention.

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