How Often Should Diabetic Feet Be Checked? Risk Categories Explained

Not everyone with diabetes has the same feet

A person newly diagnosed with type 2 diabetes, with intact sensation, good circulation and no deformity, has a low absolute risk of foot ulceration. A person with neuropathy, a previous ulcer and a clawed toe has a high one. Applying the same screening interval to both wastes effort on one and endangers the other.

This is why international diabetic foot guidance stratifies risk and sets the review interval accordingly.

The variables that determine risk

• Loss of protective sensation, assessed with a 10g monofilament.
• Peripheral arterial disease, assessed by pulses and, where indicated, ankle-brachial index.
• Foot deformity, such as claw toes, hammer toes, bunions, or Charcot change.
• Callus, which marks a pressure concentration.
• A previous ulcer.
• A previous amputation.
• End-stage renal disease, which markedly increases risk.

How the categories work, in principle

1. No neuropathy, no peripheral arterial disease, no other risk factors: annual review.
2. Neuropathy, or peripheral arterial disease, or deformity: more frequent review, typically every few months.
3. Neuropathy plus peripheral arterial disease, or plus deformity: frequent specialist review.
4. Previous ulcer, previous amputation, or end-stage renal disease: the highest-risk category, with review often every one to three months.

The exact intervals vary between guidelines and health systems. The principle does not: risk determines frequency, and previous ulceration is the strongest single flag.

The gap between appointments

Even in the highest-risk category, a review every eight weeks means roughly 56 days between examinations. A diabetic foot ulcer does not take 56 days to form. This is the fundamental limitation of episodic screening: the surveillance interval is longer than the disease process.

This is not a criticism of the guidance, which is sensible given finite clinical resources. It is an argument for what fills the gap.

What continuous monitoring is for

Daily self-inspection is one answer, and it is the standard recommendation. Continuous sensing is another, and it does not depend on the patient remembering, seeing well, or being able to reach their feet.

Mi Terro Care Socks are designed to add temperature, pressure, gait, and activity context between appointments. They do not replace daily inspection, risk-based screening, or professional review.