Diabetes Foot Management

Diabetes Foot Management – challenges to address

Why is Diabetes Foot Care important?

  • Annual cost of Diabetes Foot Care is estimated at £1Billion*
  • High social and personal cost due to reduced quality of life, mobility and productivity
  • Around 64, 000 people with diabetes foot ulcers at any given time**
  • Complications with diabetes foot ulcers not healing may result in amputations
  • Estimated 7000 foot or toe amputations for patients with diabetes each year*
  • Survival rates are poor for people with diabetes foot ulcers and even more so if amputation has occurred

*NDFA England data ** England and Wales data

NDFA Key Findings & Key Recommendations – Care Structures

The National Diabetes Foot Care Audit (NDFA) is a measurement system of care structures, patient management and the outcomes of care for people with active diabetic foot ulcers. Here are key highlights from the NDFA Third Annual Report (England and Wales) published 14 March 2018:

NICE recommends three Care Structures to support effective prevention and management of diabetes foot disease;

1/ Training for routine foot screening 2/ Foot Protection service pathway 3/ Foot Disease referral to expert pathway

Key findings

  • Less than half of participating commissioners provide all three NICE-recommended care structures.
  • Pathways for rapid expert assessment are associated with shorter time to assessment and less severe ulcers.
  • Pathways for rapid expert assessment are associated with better healing outcomes.


Commissioners should work with local providers to ensure pathways meet NICE guidelines

NDFA Key Findings & Key Recommendations – Time to first expert assessment

Commentary, NDFA Team:

“The evidence derived from over 20,000 new diabetic foot ulcers suggests that early referral is associated with ulcers of lesser severity, and lesser severity is associated with better outcomes.”


All people with diabetic foot ulcers should be referred promptly for early specialist assessment, in line with NICE guidance.

NDFA Key Findings & Key Recommendations – Alive and ulcer-free

Key findings

  • People are alive and ulcer-free at 24 weeks in only two thirds of cases of a diabetic foot ulcer.
  • Severe ulcers take longer to heal.
  • Outcomes are worse if the time to first expert assessment is ≥14 days.



  • All people with diabetic foot ulcers should be referred promptly for early specialist assessment, according to NICE guidance.
  • Providers should endeavour to record all new instances of diabetic foot ulcers, and to complete outcome data for all patients registered in the audit, in order to ensure a more complete picture of patient outcomes.
  • All audit participants should engage with audit-driven quality improvement work.

‘There has been an additional £10 million transformation fund investment by NHS England to establish MDFTs where they do not exist currently, and to expand multi- disciplinary foot care service capacity where additional capacity is required.’    NHS England, NDFA March 2018 Report

Resources for further information

To read the full NDFA Report and relevant NICE Guidelines please follow these links (to external websites)

NDFA Report (2014-2017) England and Wales, Published March 2018
Link here


NICE Guidelines Diabetic foot problems: prevention and management (NG19)
Link here


NHS England Diabetes Transformation Fund 2017-2019

Link here

Hover over to pause the information

Silhouette as a Technology-enabler for Diabetes Foot Care Transformation

The Silhouette digital wound assessment and information management solution can be integrated into progressive models of diabetes foot care: 

  1. Improving monitoring and reporting of DFU outcomes – quantification of DFU outcomes and progress using Silhouette digital imaging, 3D ulcer measurement and healing progress charts & reports.
  2. Enabling rapid referral time and escalation/de-escalation as appropriate – using real time Silhouette ulcer images and ulcer healing data to establish risk status of DFU patient, as well as to inform treatment plan to achieve target outcomes.
  3. Increasing MDFT service access and continuity of care – access to real time DFU data on shared Silhouette platform helps to join up care across acute and community settings, with flexibility on where patient can be assessed and treated.
  4. Releasing capacity in acute out-patient appointments and enabling care closer to home – by building greater capability for patients to be seen in community.

Learn about the EMAHSN Diabetes Foot Digital Solution (Silhouette) in South Derbyshire


“As a result of implementing the Silhouette system, we have been able to safely transfer an increasing portion of patients for treatment in community clinics and have improved waiting times in our out-patient clinic. Importantly, patients are happy with the new model of care. In a survey following introduction of digital ulcer assessment, 71% of patients reported a greater confidence in the care they had received.”

Professor Fran Game, Consultant Diabetologist, Clinical Director R&D, Derby Teaching Hospitals NHS Foundation Trust


Reference Sites & Client Testimonials

The Silhouette solution has been successfully adopted by a number of NHS Diabetes Foot Services to support Diabetes Foot Care Transformation. Please contact Entec Health if you would like to be put in touch with Clinical Innovators from these reference sites.

Case Studies & Evidence

Request EMAHSN Diabetes Foot Digital Solution Business Case     


EWMA Conference e-Poster Presentation May 2017

Early results from a technology-enabled integrated diabetes foot service. F.Game et al., Derbyshire Teaching Hospitals NHS Foundation Trust


Diabetes Foot Study Group Conference September 2017

Sixty percent area reduction at 2 weeks can be a useful predictor of eventual diabetic foot ulcer healing by 12 weeks. T.Jemmott et al., King’s College Hospital NHS Foundation Trust


AHSNs Atlas of Innovation Case Study 2016

Diabetes Foot Ulcer Service Digital Imaging and Assessment Service (Silhouette®)


NHS High Impact Innovations March 2013

Going digital for assessing and managing patients with diabetic foot ulcers. M.Bates, King’s College Hospital NHS Foundation Trust