Introduction to wounds on a high-risk foot

A high-risk foot is a foot at high risk of amputation, ulceration or infection due to complications from a chronic disease. A high-risk foot is diagnosed in people with two or more risk factors (neuropathy, peripheral arterial disease, foot deformity), or a current or previous foot wound or amputation.

Diabetes is the most common condition placing the foot at high risk. Foot disease is the leading cause of hospitalisation for people with diabetes, and is the most common cause of nontraumatic lower-limb wounds and amputation. A foot wound in a patient with diabetes often occurs as a result of a complex combination of peripheral neuropathy, peripheral arterial disease and infection.

Other chronic conditions such as rheumatoid arthritis, peripheral arterial disease, scleroderma and gout can place the foot at risk of a wound or amputation. These conditions (and diabetes) share a common pathway to ulceration, namely joint deformity, reduced peripheral arterial blood flow, and reduced pain perception. Foot deformity, decreased pain perception and gait changes also contribute to abnormal pressures on the foot or toes causing calluses or corns. If a callus or corn is not appropriately managed in a high-risk foot, skin breakdown and ulceration can occur; early referral to a podiatrist is recommended.

For advice on routine foot care and monitoring in diabetes, see Foot care for patients with diabetes.