A simple rule to identify people with diabetes at risk of foot ulceration

There is a need for a simple rule based on the sort of clinical data generated by annual review examinations, which predicts those at risk of foot ulcers with reasonable specificity and sensitivity. We have used data on 5153 patients free of ulcer or amputation at registration who were followed up at University Hospital Nottingham for between1 and 12.4 years. A ‘sensitive’ rule using neuropathy and pulse ‘scores’and HbA1 predicted 95% of those who developed an ulcer and missed only one person out of 39 who worsened to amputation. The rule seemed fairly effective when tested on data from Nottingham City Hospital and although developed and tested on outpatient attenders, the rule should be relevant in primary care.