Published May 2026. Written by the Upwell Health Collective clinical team. Clinically reviewed May 2026. Next review November 2026. For educational purposes only — please consult a qualified podiatrist, GP, endocrinologist, or your diabetes care team for personalised advice. If you have any of the red flag symptoms described in this guide, seek medical attention urgently.
Related reading from Upwell Health:
• Podiatry Camberwell — Award-Winning Podiatrist Near You
• The Tendinopathy Ultimate Guide 2026
• The Disc Injury Directory 2026
• Perimenopause & Menopause Thrive Guide 2026
• Pain Is Not Damage
If you have type 1 or type 2 diabetes — five things to know about your feet before anything else:
1/ Diabetic foot complications are the most under-recognised serious diabetes complication in Australia. Around 1.9 million Australians live with diabetes. Approximately 50,000 people in Australia have a diabetes-related foot ulcer at any given moment. 4,400 lower limb amputations occur in Australia each year due to diabetes — the equivalent of 12 amputations per day. Yet most people with diabetes have never had a proper foot assessment.
2/ Most diabetic foot problems are preventable. The IWGDF (International Working Group on the Diabetic Foot) 2023 Guidelines — the global gold standard — confirm that structured annual foot assessment, appropriate footwear, daily self-care, and early intervention prevent up to 85% of diabetes-related amputations. Prevention works. The system just doesn't deliver it consistently.
3/ The two silent killers are neuropathy and peripheral arterial disease. Diabetic peripheral neuropathy (loss of protective sensation) affects up to 50% of people with long-standing diabetes — and most don't know they have it. Peripheral arterial disease (reduced blood flow to the feet) compounds the problem. Together, they create the conditions where a small cut, blister, or pressure point becomes a non-healing ulcer, infection, or limb-threatening emergency — often without pain to warn you.
4/ Your annual diabetic foot assessment is funded — most people just don't access it. Medicare provides up to 5 Chronic Disease Management (CDM) podiatry sessions per calendar year for eligible diabetic patients. NDIS participants with diabetes can access podiatry through their plan. DVA bulk-bills eligible veterans. Yet uptake remains poor — a gap Upwell exists to close.
5/ The modern diabetic foot toolkit is dramatically more hopeful than 10 years ago. Advanced wound care, total contact casting, removable cast walkers, modern offloading orthoses, vascular interventional radiology, hyperbaric oxygen therapy where indicated, GLP-1 medications (Ozempic, Mounjaro, Wegovy) that improve wound healing trajectories, and integrated multidisciplinary clinics have transformed outcomes for diabetic foot patients across the past decade. The science is good. Getting people connected to it is the challenge.
This guide is the most comprehensive evidence-based diabetic foot care resource we've produced. It covers risk classification, neuropathy and peripheral arterial disease, the IWGDF 2023 Guidelines, daily self-care, footwear, the Charcot foot, ulcer management, infection, surgical decision-making, the modern medication landscape, and the multidisciplinary care that prevents amputations. It sits at around 15,000 words.
The scale of the problem is staggering and largely invisible to the broader public.
The numbers:
• Approximately 1.9 million Australians live with diabetes — around 7% of the population, plus an estimated 500,000 with undiagnosed type 2 diabetes.
• 50,000 Australians have a diabetes-related foot ulcer at any given moment.
• The lifetime risk of developing a foot ulcer for a person with diabetes is approximately 19–34%.
• Following a first foot ulcer, recurrence rates approach 40% within 1 year and 65% within 5 years.
• 4,400 lower limb amputations per year in Australia are diabetes-related.
• 5-year mortality after a major diabetes-related amputation exceeds 50% — worse than most common cancers.
• Diabetes-related foot complications cost the Australian health system over $1.6 billion annually.
Despite these figures, diabetic foot care receives a fraction of the public health attention given to other diabetes complications. Most Australians with diabetes have never had their feet properly assessed. Most have never been formally risk-stratified. Most don't know whether they have neuropathy or peripheral arterial disease. The gap between what's possible and what most diabetic patients experience is one of the widest in modern healthcare.
This guide exists to close that gap.
Diabetes affects your feet through three primary mechanisms — each one bad enough on its own, devastating in combination.
Persistent high blood glucose damages peripheral nerves over years. The longest nerves in the body — those running to the feet — are typically affected first. The result: gradual loss of the ability to feel pain, temperature, vibration, and pressure in the feet.
This is the single most important diabetic foot risk factor. Why? Because pain is your protective alarm system. When that alarm doesn't work, small injuries that would normally cause you to stop and act — a poorly-fitting shoe rubbing, a pebble in your shoe, walking on a hot surface, an ingrown toenail, a small cut — go unnoticed. The tissue damage progresses. The next thing you notice is an ulcer or infection.
Diabetic peripheral neuropathy affects:
• Up to 50% of people with diabetes for more than 10 years.
• Higher prevalence with poor glycaemic control.
• More common in older adults, men, taller people, smokers, and those with peripheral arterial disease.
• Often asymptomatic until protective sensation is significantly impaired.
The symptoms (when present) include:
• Numbness in the feet — the classic "walking on cotton wool" sensation.
• Tingling, burning, or shooting pain (especially at night).
• Pins and needles.
• Loss of sensation to light touch.
• Loss of vibration sense.
• Reduced ankle reflexes.
• Foot deformity over time (claw toes, hammer toes, Charcot changes).
Critically: many people with diabetic neuropathy have no symptoms at all. The first sign of neuropathy is often the ulcer that wouldn't have happened if the nerves were working properly. Screening matters.
Diabetes accelerates atherosclerosis (narrowing of arteries from plaque buildup) throughout the body. The arteries supplying the lower limbs are commonly affected. The result: reduced blood flow to the feet, impaired healing capacity, and elevated risk of tissue death (gangrene).
Peripheral arterial disease (PAD) affects approximately 20–30% of people with diabetes over 50. The classic symptom — intermittent claudication (cramping pain in calves with walking) — is often absent in diabetic patients because coexisting neuropathy masks the pain.
Signs that PAD may be present:
• Cold feet, particularly compared to the rest of the body.
• Pale or bluish skin on the feet.
• Shiny, hairless skin on the lower legs.
• Slow nail growth.
• Slow wound healing on the feet.
• Cramping in the calves, thighs, or buttocks with walking (claudication).
• Rest pain in the feet (typically worse at night).
• Diminished or absent foot pulses.
Assessment of PAD is a core part of diabetic foot screening — covered in the assessment section below.
Diabetes affects multiple aspects of wound healing:
• Impaired neutrophil function reduces ability to fight bacterial infection.
• Reduced collagen synthesis slows tissue repair.
• Microvascular disease (small blood vessel narrowing) reduces oxygen delivery to wound beds.
• Glycation of proteins alters connective tissue properties.
• Higher inflammatory marker baseline impairs the orderly healing cascade.
The combination of neuropathy + PAD + impaired healing means that a problem that would resolve quickly in a non-diabetic foot can rapidly become limb-threatening in a diabetic foot. This is why even minor diabetic foot problems need prompt assessment — there's no such thing as "just a small cut" once these mechanisms are in play.
• Foot deformity — bunions, hammer toes, claw toes, Charcot deformity all create pressure points where ulcers form.
• Reduced joint mobility — limited ankle dorsiflexion increases forefoot pressure during walking.
• Visual impairment — diabetic retinopathy reduces ability to self-inspect feet.
• Reduced flexibility — obesity, back problems, and arthritis reduce ability to physically reach and inspect feet.
• Footwear — ill-fitting shoes are the single most common precipitant of diabetic foot ulcers.
• Smoking — dramatically worsens PAD and wound healing.
• Renal disease — dialysis patients have the highest amputation rates in diabetes.
• Prior foot ulcer or amputation — the single strongest predictor of future ulceration.
The International Working Group on the Diabetic Foot (IWGDF) publishes the global evidence-based guidelines for diabetic foot care. The 2023 Guidelines — a comprehensive update of the 2019 version — are the framework every modern diabetic foot service is built around. The five core guideline documents cover:
1/ Prevention — risk stratification, screening, footwear, education, and follow-up.
2/ Offloading — pressure relief for active and healed ulcers.
3/ Diagnosis and treatment of infection — antibiotics, debridement, hospitalisation.
4/ Peripheral artery disease — assessment and management of vascular disease.
5/ Wound healing — dressings, advanced therapies, and adjuncts.
The most important practical contribution of the IWGDF is the risk stratification framework — a simple, validated system that classifies every person with diabetes into one of five risk categories based on assessment findings. The category determines the screening frequency, the level of intervention, and the funding pathway.
Risk 0 (Very low risk). No loss of protective sensation, no PAD. Annual foot assessment.
Risk 1 (Low risk). Loss of protective sensation OR PAD. 6–12 monthly assessment.
Risk 2 (Moderate risk). Loss of protective sensation AND PAD, OR loss of protective sensation AND foot deformity, OR PAD AND foot deformity. 3–6 monthly assessment.
Risk 3 (High risk). Loss of protective sensation OR PAD AND one or more of: previous foot ulcer, previous lower extremity amputation, end-stage renal disease. 1–3 monthly assessment.
Active foot disease. Current foot ulcer, Charcot foot, infection, or critical limb ischaemia. Immediate specialist multidisciplinary team involvement.
Knowing your IWGDF risk category is the single most useful piece of information about your diabetic foot status. Ask your podiatrist or GP. If they don't know, find a podiatrist who does.
The National Diabetes Services Scheme (NDSS) provides Australian-specific resources for diabetic foot care, including the National Diabetes Foot Network resources and Diabetes Feet Australia (DFA) clinical pathway guidance. The Australian framework aligns closely with IWGDF principles, adapted to Australian funding pathways:
• Medicare Chronic Disease Management (CDM) plans — up to 5 podiatry sessions per calendar year for eligible patients.
• NDIS funding for diabetic foot care under participant plans.
• DVA Gold Card and White Card podiatry funding.
• Public diabetic foot clinics in larger hospitals (multidisciplinary teams).
• Specialist endocrinology, vascular surgery, and orthopaedic services in major hospitals.
Your annual (or more frequent) diabetic foot assessment with a podiatrist should be comprehensive. At Upwell, a thorough diabetic foot assessment includes:
• Diabetes type, duration, and glycaemic control (HbA1c).
• Other diabetes complications (retinopathy, nephropathy).
• Cardiovascular history.
• Previous foot problems, ulcers, infections, or amputations.
• Footwear habits.
• Activity level.
• Smoking status and cessation interest.
• Current medications (especially relevant for any that affect healing: steroids, biologics, GLP-1 agonists).
• Skin colour, temperature, hydration.
• Areas of callus, corns, fissures.
• Nails — thickness, colour, fungal infection, ingrown nails.
• Interdigital spaces for fungal infection or maceration.
• Any cuts, blisters, ulcers, or recent injuries.
• Hair distribution on lower legs (loss suggests PAD).
10g monofilament test — the gold standard screening tool for protective sensation. A specifically calibrated 10g monofilament is pressed against multiple specific sites on the foot until it buckles. The patient indicates each touch with their eyes closed. Loss of sensation at 4 or more sites indicates significant loss of protective sensation.
128Hz tuning fork — tests vibration perception. Applied to the dorsum of the great toe. Absent or reduced perception confirms peripheral neuropathy.
Reflexes — Achilles tendon reflex testing.
Light touch and pinprick — supplementary sensory testing.
Neurothesiometer — in some clinical settings, this provides quantitative vibration perception threshold measurement.
Foot pulses — palpation of the dorsalis pedis and posterior tibial pulses.
Capillary refill — pressing on the toe nail and observing return of colour. Slow refill (>3 seconds) suggests reduced perfusion.
Skin temperature — comparing both feet. A cold foot suggests reduced perfusion.
Ankle-brachial index (ABI) — where indicated, measurement of ankle blood pressure compared to arm blood pressure. ABI <0.9 suggests PAD; ABI >1.3 may indicate vessel calcification (common in diabetes) which makes the test unreliable.
Toe-brachial index (TBI) — more reliable than ABI in patients with vessel calcification.
Doppler ultrasound — audible Doppler assessment of foot pulses where palpation is unclear.
• Foot shape and posture.
• Toe deformities (hammer, claw, mallet, retracted).
• Bunion or other forefoot deformity.
• Charcot changes (foot shape, swelling, warmth).
• Joint mobility — particularly ankle dorsiflexion and first MTP joint.
• Areas of high pressure (callus distribution often indicates these).
• Plantar pressure measurement where appropriate.
• Gait analysis where appropriate.
• Fit — length, width, depth.
• Construction — cushioning, support, internal lining.
• Internal inspection for foreign objects, worn-out areas, internal seams.
• Wear pattern on the sole.
• Appropriateness for the patient's risk category and activity level.
Following the assessment, the podiatrist:
• Classifies the patient using the IWGDF risk framework.
• Communicates the risk level clearly to the patient.
• Documents findings for the patient's GP and diabetes care team.
• Develops an individualised management plan including assessment frequency, footwear advice, self-care education, and referral if indicated.
Every diabetic foot assessment should include patient education — because the day-to-day prevention work happens at home, not in the clinic.
Daily self-care is the cornerstone of diabetic foot prevention. The fundamentals:
Inspect both feet every day. Look at:
• The tops and bottoms of both feet.
• Between every toe.
• The heels and ankles.
• Toenails.
• Skin colour and temperature.
What you're looking for:
• Cuts, blisters, scratches, splinters.
• Redness, swelling, or warmth.
• Hard skin, calluses, or corns.
• Cracks (particularly the heels).
• Discolouration or bruising.
• Any change you haven't noticed before.
If you can't see the bottoms of your feet, use a mirror, ask a partner, or take a photo with your phone. If you have visual impairment, have someone check your feet daily. This is not optional.
• Wash feet daily in warm (not hot) water.
• Test water temperature with your elbow or a thermometer if neuropathy is present — hot water burns happen because the foot can't feel the heat.
• Use mild soap.
• Dry thoroughly, including between toes — trapped moisture grows fungus.
• Apply moisturiser to the tops and bottoms of feet — not between the toes.
• Cut toenails straight across, not curved into the corners.
• File nail edges smooth.
• If you can't see well or can't reach your feet, have your podiatrist or a family member trim your nails.
• Never use sharp instruments on calluses, corns, or thickened skin — cuts can be invisible and devastating in a diabetic foot.
• Don't use over-the-counter corn removers — the active acid can cause chemical burns and ulcers.
• Always wear socks with shoes.
• Change socks daily — more often if your feet sweat heavily.
• Choose seamless or low-seam socks.
• Avoid tight elastic bands at the top.
• Diabetic-specific socks (cushioned, seamless, moisture-wicking) are available and worthwhile for higher-risk patients.
• Shake out shoes before putting them on — small stones, debris, or foreign objects can cause unnoticed pressure damage in a neuropathic foot.
• Run your hand inside each shoe before putting them on.
• Never go barefoot — indoors or outdoors. Slip-on slippers with cushioned soles for around the house.
• Never wear shoes that hurt or rub. If you can't feel discomfort but see redness afterwards, that's a sign the shoes are damaging your feet — don't wear them again.
• Avoid heating pads, hot water bottles, or electric blankets directly on the feet — burns are common in neuropathic feet.
• Avoid foot soaks longer than 5–10 minutes — prolonged moisture macerates skin and increases infection risk.
• Don't smoke. Smoking accelerates the vascular disease that worsens diabetic foot outcomes more than almost any other modifiable factor.
• Manage your blood glucose. Good glycaemic control reduces the rate of nerve damage and improves wound healing.
• Manage your cardiovascular risk factors (blood pressure, cholesterol, weight).
• Stay active. Regular activity improves circulation, blood glucose control, and overall foot health.
See your podiatrist or GP urgently if you notice:
• Any new wound, blister, or break in the skin on your foot.
• Redness, warmth, or swelling.
• Pus or discharge.
• A foul smell.
• Change in foot colour (red, blue, black, purple, pale).
• Sudden change in foot shape or temperature.
• Increasing or new pain (or sometimes — importantly — a sudden change in your usual numbness pattern).
• Fever or feeling unwell with a foot problem (suggests systemic infection).
The rule: when in doubt, get it checked the same day. A 24-hour delay can be the difference between a treated minor problem and a hospital admission. Diabetic foot infections progress fast.
Ill-fitting footwear is the single most common precipitant of diabetic foot ulcers. The principles of diabetic footwear:
• Length — at least 1cm (a thumb's width) between the longest toe and the end of the shoe when standing.
• Width — enough room across the forefoot that the foot is not compressed. The shoe should fit the widest part of the foot.
• Depth — enough vertical room for the toes to lie flat without pressing against the upper.
• Construction — soft upper materials, smooth seamless lining, adequate cushioning, supportive heel counter.
• Closure — laces or velcro that allow adjustment for swelling through the day.
• Sole — cushioned and rigid enough to protect the foot from underneath. Slip-resistant.
• Toe box — rounded, not pointed. No pressure on toes.
• High heels (>2cm).
• Pointed toe boxes.
• Open-toed sandals (for higher-risk patients).
• Thongs/flip-flops between the toes (irritation, no support).
• Walking barefoot — anywhere, indoors or outdoors.
• Tight shoes you'll wear in — there's no wearing in a neuropathic foot.
For higher-risk patients (IWGDF Risk 2, 3, or active foot disease), specialist diabetic footwear is often warranted. This includes:
• Extra-depth shoes (more vertical room for toes).
• Custom-moulded inserts to redistribute pressure.
• Custom-moulded shoes for severe deformity (including post-Charcot).
• Healing shoes and post-operative footwear after ulcer surgery.
Your podiatrist can advise on appropriate footwear and may prescribe custom orthotics or specialist footwear funded through Medicare, NDIS, DVA, or private health insurance pathways.
Charcot neuroarthropathy (Charcot foot) is one of the most under-recognised diabetic foot emergencies. Early recognition can save a foot. Missed diagnosis can destroy one.
Charcot neuroarthropathy is a progressive destruction of bones and joints in a neuropathic foot. The exact mechanism is not fully understood but appears to involve repeated micro-trauma in a foot that cannot feel pain, combined with autonomic neuropathy that increases bone blood flow and accelerates bone resorption.
The result: bones fracture, joints dislocate, and the architecture of the foot collapses — often dramatically. Without recognition and offloading, the foot can deform into a "rocker bottom" shape that creates massive plantar pressure ulcers and progresses to amputation.
The classic acute Charcot foot presentation:
• Unilateral foot swelling.
• Warmth (often 2°C or more warmer than the contralateral foot).
• Redness.
• Mild to moderate pain (less than expected given the underlying bone destruction — the neuropathy masks it).
• Often no overt injury, or a minor twist or stumble that wouldn't normally cause significant damage.
The differential diagnosis is critical: acute Charcot foot is frequently misdiagnosed as cellulitis, gout, deep vein thrombosis, or osteomyelitis. The wrong diagnosis means the wrong treatment — typically continued weight-bearing while the foot's bones quietly collapse.
If a hot, swollen foot in a diabetic patient turns out to be Charcot rather than cellulitis, the management is completely different. Charcot foot requires:
• Immediate complete offloading (no weight-bearing).
• Total contact casting (typically for 3–6 months).
• Specialist multidisciplinary management.
• Long-term protective footwear.
If you have diabetes and develop a hot, swollen, unilateral foot — with or without recent injury — get to a podiatrist or diabetic foot clinic urgently. "Wait and see" is the wrong answer.
A diabetic foot ulcer is a break in the skin of the foot in a person with diabetes that has not healed within a specified timeframe (usually 2 weeks). It represents the failure of the prevention system and the entry point to the most serious diabetic foot complications.
Diabetic foot ulcers most commonly form at sites of:
• High plantar pressure (under the metatarsal heads, particularly the first and fifth).
• Deformity (under hammer toes, claw toes, bunion sites).
• Friction (heel, sides of feet, top of toes from poorly-fitting shoes).
• Direct trauma (cuts, foreign objects, burns).
• Charcot rocker-bottom deformity (typically midfoot).
Two main classification systems describe ulcer severity. The University of Texas system (more contemporary) classifies by:
• Grade (0–3): from intact skin with previous ulcer history through to bone involvement.
• Stage (A–D): clean ulcer, infected ulcer, ischaemic ulcer, ulcer with both infection and ischaemia.
The classification guides treatment intensity and prognosis. Grade 0 Stage A is very different from Grade 3 Stage D.
1/ Offloading — the single most important intervention. Pressure relief from the wound. Options include:
• Total contact casting (gold standard for plantar ulcers, but requires careful application by experienced clinicians).
• Removable cast walkers (rendered irremovable in some applications).
• Felted foam dressings.
• Healing sandals.
• Crutches or wheelchair where indicated.
• Custom offloading orthoses.
Without effective offloading, no other treatment will heal the ulcer.
2/ Wound care. Including:
• Sharp debridement of devitalised tissue (the foundation of wound bed preparation).
• Appropriate dressing selection based on wound moisture, depth, and infection status.
• Negative pressure wound therapy in selected cases.
• Advanced therapies (bioengineered tissues, growth factors, hyperbaric oxygen) in refractory cases.
3/ Infection management. Including antibiotics where appropriate, surgical drainage of abscesses, and hospitalisation for severe infections. The IWGDF infection guideline provides detailed protocols.
4/ Vascular assessment and intervention. If PAD is contributing to non-healing, vascular surgery or interventional radiology (angioplasty, stenting, bypass) may be required to restore blood flow.
This is multidisciplinary work. No single practitioner manages a complex diabetic foot ulcer alone.
Infection is the most common reason for hospital admission in diabetic foot disease. It can progress rapidly from cellulitis to deep abscess, osteomyelitis (bone infection), and sepsis. Recognition matters.
Uninfected. No purulent discharge, no signs of inflammation.
Mild infection. Local signs of infection (cellulitis <2cm), no systemic illness. Oral antibiotics typically appropriate.
Moderate infection. Larger cellulitis (>2cm), deeper tissue involvement, no systemic toxicity. Often requires intravenous antibiotics and hospital management.
Severe infection. Systemic toxicity — fever, raised inflammatory markers, hypotension, altered mental status. Hospital admission, IV antibiotics, often surgical intervention.
Osteomyelitis affects up to 20% of diabetic foot ulcers, particularly those that extend to bone. The clinical sign — visible bone or palpable bone at the base of an ulcer — is sufficient to warrant treatment in most cases, often confirmed with imaging (X-ray, MRI) and culture.
Treatment combines prolonged antibiotic therapy (6+ weeks typically) and often surgical debridement or partial bone resection. Decisions are made by specialist multidisciplinary teams.
The GLP-1 receptor agonists (semaglutide/Ozempic/Wegovy, tirzepatide/Mounjaro, liraglutide/Saxenda) have transformed diabetes care and weight management since their broad adoption. Their implications for diabetic foot care are increasingly recognised:
Positive effects:
• Substantial improvements in glycaemic control reduce neuropathy progression.
• Weight loss reduces plantar pressure and biomechanical stress.
• Cardiovascular benefits reduce systemic atherosclerosis driving PAD.
• Emerging evidence suggests improved wound healing trajectories in patients on GLP-1s.
• Reduced cardiovascular event rates in diabetic patients.
Considerations:
• Rapid weight loss can change foot shape and footwear fit — patients on GLP-1s may need footwear reassessment more frequently.
• Sarcopenia risk with rapid weight loss can affect lower limb strength and balance.
• Possible association with various surgical and anaesthetic considerations (gastric emptying delay).
• The role in ulcer healing protocols is still being established.
If you're on GLP-1 therapy, mention it at your diabetic foot assessment. Your podiatrist can incorporate the implications into your individualised care plan.
Diabetic foot care doesn't exist in isolation. The systemic management of diabetes directly affects foot outcomes:
HbA1c target individualised but typically <7% for most adults with diabetes. Tighter control reduces neuropathy progression. Episodes of severe hypoglycaemia carry their own risks. Discuss targets with your endocrinologist or GP.
• Blood pressure target typically <130/80.
• Lipid management with statin therapy in most adults with diabetes.
• Aspirin or other antiplatelet therapy where indicated.
• Cardiovascular review and screening.
The single highest-impact lifestyle intervention for diabetic foot outcomes. Smoking dramatically accelerates PAD, impairs wound healing, and increases amputation risk. Cessation support is available through GPs, Quitline (13 7848), and nicotine replacement therapy.
Diabetic kidney disease (diabetic nephropathy) is the strongest predictor of poor foot outcomes. Dialysis patients have dramatically elevated amputation rates. Renal function should be monitored as part of routine diabetes care.
Adequate protein intake, micronutrient status (particularly vitamin D, zinc, iron), and overall nutrition status affect wound healing capacity. Dietitian involvement is valuable for patients with active foot disease or weight management goals.
Depression is more common in diabetes than the general population and substantially worsens self-care behaviours — including foot care. Screening and treatment matter.
Foot complications occur in type 1 diabetes but at lower absolute rates than type 2 due to younger onset age and lower vascular comorbidity. Long-duration type 1 diabetes still carries substantial risk — the same screening and prevention principles apply.
Generally no specific foot care implications during pregnancy. However, gestational diabetes substantially increases lifetime risk of type 2 diabetes — ongoing risk monitoring is appropriate.
Older adults with diabetes carry the highest absolute risk of foot complications due to longer disease duration, accumulated comorbidities, and physical/cognitive factors affecting self-care. More frequent assessment is appropriate.
Indigenous Australians have substantially higher rates of diabetes and diabetes-related foot complications, including dramatically elevated amputation rates. Targeted programs and culturally appropriate care pathways are essential.
Distance from specialist services is a major risk factor. Telehealth podiatry, training of local primary care teams, and timely transfer protocols all matter.
Diabetes and its complications are not in themselves NDIS-eligible conditions, but NDIS participants with underlying disability who also have diabetes can access podiatry through their plan for diabetic foot care. Upwell is a registered NDIS provider — we work with participants across the inner east.
Complex diabetic foot disease is multidisciplinary work. The team often includes:
• Podiatrist — the central foot care clinician for screening, prevention, biomechanics, footwear, and ulcer management.
• GP — coordinator of overall diabetes care, prescriber, gatekeeper to Medicare and other funding.
• Endocrinologist — specialist diabetes management, particularly for complex or poorly-controlled disease.
• Vascular surgeon — assessment and intervention for PAD.
• Interventional radiologist — angioplasty and stenting.
• Infectious disease physician — complex infections, osteomyelitis.
• Orthopaedic foot and ankle surgeon — surgical intervention, Charcot reconstruction.
• Wound care nurse — advanced wound management.
• Diabetes educator — patient education and self-management support.
• Dietitian — nutrition support.
• Diabetes nurse practitioner — specialist nurse-led care.
• Pharmacist — medication management.
Communication between team members is the unsung hero of good diabetic foot outcomes. At Upwell, our podiatry team works closely with referring GPs, endocrinologists, and specialists to keep your care coordinated.
At Upwell Health Collective in Camberwell, we provide comprehensive diabetic foot care for patients across Melbourne's inner east. Our integrated allied health team brings podiatry, physiotherapy, exercise physiology, clinical Pilates, and myotherapy together under one roof. For diabetic patients, our service includes:
Full history, neurological screening (10g monofilament, vibration), vascular assessment (pulses, capillary refill, ABI/TBI where indicated), skin and nail review, biomechanical assessment, footwear review, IWGDF risk classification, and individualised management plan. Reports sent to your GP and diabetes care team.
Follow-up frequency tailored to your IWGDF risk category — from annual review for low-risk patients to monthly review for high-risk patients.
For patients with active ulcers, infections, Charcot foot, or critical limb ischaemia, we coordinate with specialist vascular, orthopaedic, and endocrinology services. We don't try to manage active disease in isolation — we work with the team.
Footwear assessment, advice, and custom orthotic prescription where indicated. We can prescribe specialist diabetic footwear through Medicare, NDIS, and DVA pathways for eligible patients.
Detailed patient education on daily self-care, footwear, when to act fast, and how to be your own first line of defence. The clinic visit is the start, not the end, of diabetic foot care — the work happens at home every day.
Our podiatrists work alongside our physiotherapy and exercise physiology teams where relevant — particularly for diabetic patients with broader mobility, balance, falls prevention, or chronic pain issues. Our exercise physiology team works with diabetic patients on structured exercise programs that support glycaemic control, cardiovascular health, weight management, and overall function.
• Medicare CDM (EPC) plans — up to 5 sessions per calendar year for eligible patients. Speak to your GP.
• NDIS — we are a registered NDIS provider.
• DVA — bulk-billed for Gold Card and eligible White Card holders.
• Private health insurance — all major Australian health funds accepted via HICAPS.
• Private fee-for-service — transparent pricing available from our reception team.
Call our Camberwell clinic on (03) 8849 9096 or visit our podiatry page to book.
If you have diabetes, your wider care team should include:
• A GP with diabetes expertise as your central coordinator.
• An endocrinologist for complex disease.
• A diabetes educator (often a credentialled diabetes nurse) for self-management support.
• A dietitian.
• An ophthalmologist or optometrist for annual eye screening.
• A podiatrist for annual or more frequent foot screening.
• Other specialists as needed.
Most of this care is funded through Medicare, NDIS, DVA, or private health insurance pathways. The system exists. Getting connected to it is the work — and the work is worth doing.
• National Diabetes Services Scheme (NDSS) — ndss.com.au, 1800 637 700. Subsidised products, education, and resources for registered Australians with diabetes.
• Diabetes Australia — diabetesaustralia.com.au. National peak body, advocacy, education, and support.
• Diabetes Feet Australia (DFA) — diabetesfeetaustralia.com.au. National diabetes foot care organisation, clinical guidelines, professional resources.
• The Australian Podiatry Association — podiatry.org.au. Directory of registered podiatrists.
• Your local public hospital diabetic foot clinic — for active foot disease management. Royal Melbourne Hospital, Alfred Hospital, Austin Hospital, and Box Hill Hospital all have diabetic foot services in Melbourne.
Minimum annual review for all people with diabetes. More frequent (3–12 monthly) for higher-risk categories based on your IWGDF risk classification. Active foot disease may require weekly or even more frequent visits.
No referral is needed for private fee-for-service consultations. For Medicare CDM (EPC) plan rebates, your GP will need to prepare the plan first.
Yes, with a CDM plan from your GP. Eligible patients can access up to 5 Medicare-rebated podiatry sessions per calendar year. The Medicare rebate is approximately $60 per session, with most clinics charging a manageable gap.
Yes. We are a registered NDIS provider. NDIS funding can cover diabetic foot care for participants with eligible disabilities. Speak to our reception team about how to access this through your plan.
Possibly. Many people with significant diabetic neuropathy have no symptoms at all — the loss of sensation is itself the problem. Only an examination with a 10g monofilament and other tests can confirm or refute it.
That's exactly the problem. Neuropathy removes your protective sensation. Minor injuries that would normally cause you to stop and act go unnoticed. The first sign of damage is often the ulcer, not the pressure or friction that caused it. Daily inspection becomes your replacement alarm system.
Yes — if you have diabetes. A cut that would be insignificant in a non-diabetic foot can become a non-healing ulcer or infection rapidly in a diabetic foot. Clean it, dress it, and have it reviewed by a podiatrist or GP if it doesn't heal within a week or shows any sign of redness, swelling, warmth, or discharge.
No. Even at home, walk in slip-on slippers or shoes. Small injuries (stepping on a piece of glass, a Lego brick, a pen lid) are common at home and devastating in a neuropathic foot.
For higher-risk patients, yes. Diabetic-specific socks (cushioned, seamless, moisture-wicking, no constricting elastic) reduce the risk of pressure points and friction injuries. The cost is modest. The benefit is real.
For lower-risk patients with good vision and good circulation, careful nail care at a reputable salon is generally fine — but no cuticle removal, no aggressive callus reduction, and ensure tools are sterile. For higher-risk patients, see a podiatrist instead. The risk of an unrecognised infection from a salon pedicure is real.
Most likely not. Most people with diabetes do not develop foot ulcers, do not develop infections, and do not require amputation. Risk is concentrated in those with neuropathy, PAD, prior ulcers, and poor glycaemic control. Knowing your risk category, attending your annual review, daily self-care, and acting fast when problems develop dramatically reduce your individual risk.
Get a second opinion from a vascular surgeon or specialist diabetic foot clinic before consenting. Limb-salvage options have expanded substantially over the past decade — advanced vascular intervention, complex wound care, and limb-preservation surgery can sometimes save feet that would have been amputated 10 years ago. Not always. But the decision deserves specialist input.
Yes, often positively — through improved glycaemic control, weight loss, and cardiovascular benefit. But rapid weight loss can change foot shape, footwear fit, and lower limb strength. Mention any GLP-1 medication at your diabetic foot assessment so your podiatrist can adjust your care plan accordingly.
Common in older adults, obese patients, and people with back problems or arthritis. Solutions include a long-handled mirror for inspection, a partner or family member trained to check your feet daily, photos with a phone, regular podiatry visits for nail and skin care, and home help services for some patients.
The diabetic foot represents one of the most preventable serious diabetes complications. The evidence base is mature. The IWGDF Guidelines are clear. Australian funding pathways exist. Multidisciplinary care works. Outcomes for engaged, well-supported diabetic patients are dramatically better than the population averages would suggest.
The barriers to good outcomes are not scientific. They are:
• Patients not knowing their risk category and not getting screened.
• GPs and clinicians not consistently applying screening protocols.
• Medicare CDM and NDIS funding pathways being under-utilised.
• Footwear advice being absent from routine diabetes care.
• Active foot disease being managed too late in primary care rather than escalated to specialist multidisciplinary teams.
• Misdiagnosis of acute Charcot foot as cellulitis or DVT.
• Smoking, poor glycaemic control, and untreated cardiovascular risk going unaddressed.
If you have diabetes — know your foot risk category. Get your annual review. Inspect your feet daily. Wear appropriate footwear. Don't smoke. Act fast on new problems. Build a team. The system exists. Use it.
Whenever you need allied health support for your diabetic foot care, Upwell Health Collective is here. Our Camberwell team works with diabetic patients across every risk category — from newly-diagnosed type 2 patients with no foot problems through to high-risk patients with previous ulcer history requiring frequent specialist input.
To book an appointment, visit our Podiatry Camberwell page or call our clinic on (03) 8849 9096. We see patients privately, on Medicare CDM plans, NDIS plans, DVA, and TAC. We bulk-bill DVA Gold Card holders.
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A note from Team Upwell
This guide is the most comprehensive evidence-based diabetic foot care resource we've produced. It integrates research from 2023–2026 across the IWGDF Guidelines, Australian-specific clinical pathways, the modern medication landscape, and the multi-disciplinary care that prevents amputations. We've built it to be useful to people with diabetes, their families, GPs, and allied health clinicians — anyone touched by the most preventable serious diabetes complication.
If you spot something we've got wrong, or if the evidence has updated since publication, please reach out. We update this guide every six months. Our next scheduled review is November 2026.
Know your risk. Check your feet daily. Get connected to a team. The science is good. Use it.
With care,
— Team Upwell, Camberwell