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Independent pharmacists can provide foot health screening, identify potential red flags, provide self-care advice and refer, as Kathy Oxtoby explains…

Diabetes is “the most common cause of non-traumatic limb amputation, with diabetic foot ulcers preceding more than 80 per cent of amputations in people with diabetes”, says the National Institute for Health and Care Excellence (NICE).¹

More than 7,000 diabetes-related amputations are reported in the UK per year.¹ Pharmacists working in the community have “an important role in helping prevent serious diabetic foot complications through early intervention”, says Tase Oputu, president of the Royal College of Pharmacy.

“Every interaction with someone living with diabetes is an opportunity to reinforce good foot care, encourage regular self-checks and recognise when symptoms need further assessment.

“While pharmacists don't replace routine diabetic foot assessments, they can help identify concerns such as wounds that aren't healing, changes in skin colour, swelling or signs of infection, and make sure people are referred promptly through the appropriate care pathway.

“Encouraging people to seek advice early, rather than waiting for symptoms to worsen, can make a significant difference,” she adds.

Pharmacists can undertake a basic foot health screening and visual inspection, identify potential red flags, provide self-care advice and refer patients appropriately, says Jacquie Lee, Numark medication safety officer and information pharmacist.

Increasingly, pharmacists are delivering clinical services such as hypertension case-finding, weight management and diabetes support, she says. “Adding opportunistic diabetic foot awareness checks during medicines reviews or consultations can help identify patients who may otherwise fall through the gaps."

A screening intervention rather than a diagnostic assessment

She says a pharmacy foot check should be viewed as “a screening intervention rather than a diagnostic assessment”. Some questions that could be included are:

·     Have you had your annual diabetic foot check?

·     Do you inspect your feet every day?

·     Have you noticed any cuts, blisters, cracks, ulcers or swelling?

·     Have you experienced numbness, tingling or burning sensations?

·     Do you have pain when walking that improves with rest?

·     Have you previously had a foot ulcer or amputation?

“These questions help identify patients at risk of neuropathy, peripheral arterial disease and foot ulceration. With the patient's consent, pharmacists may visually inspect the feet as any break in the skin in a person with diabetes warrants particular attention,” she says.

Ms Lee says red flags where pharmacists should urgently refer patients include: new ulceration, foot infection, pus or discharge, blackened or necrotic tissue, sudden redness, warmth and swelling, suspected Charcot foot, rapidly worsening pain, and signs of critical limb ischaemia.

NICE recommends urgent specialist assessment for active diabetic foot problems.¹ These patients should not be managed solely through self-care advice, says Ms Lee.

She says community pharmacists can help prevent diabetic foot amputations by promoting daily self-inspection, encouraging good glycaemic control, and addressing modifiable cardiovascular risk factors such as blood pressure, lipids and bodyweight.

They can also help prevent these amputations by educating about foot emergencies as early intervention dramatically reduces the risk of hospitalisation and amputation, and by promoting appropriate footwear to reduce pressure damage and ulceration, she says.

Gurvinder Najran, the lead pharmacist at The Greens Health Centre in Dudley, who also teaches pharmacy undergraduates at Keele University, says pharmacists can promote healthy lifestyle choices such as smoking cessation, nutrition and exercise. They can also provide patient education on self-care, such as on proper foot care techniques and identifying symptoms of diabetes-related foot problems, which include tingling sensations or numbness, burning pain and non-healing cuts, wounds or sores, he says.

A range of specialised foot and leg care products

Pharmacists can assist patients in accessing resources for diabetes management, such as: supporting patients’ attendance of eye screening programmes, diabetes education courses, and regular foot and leg checks, says Mr Najran.

Pharmacies can offer a range of specialised foot and leg care products for patients.

Regarding products for dry skin and cracked heels, urea-based foot creams are considered one of the most effective moisturising ingredients for diabetic feet, says Ms Lee. “They improve hydration, reduce scaling, prevent skin breakdown and softening of callused skin.”

Suitable pharmacy recommendations for compression and circulation support products may include diabetic-friendly socks with seam-free construction and moisture-wicking fabrics that help reduce pressure points and skin damage, she says.

Graduated compression hosiery should not be supplied without appropriate assessment where significant vascular disease is suspected, she says. “Pharmacists must be mindful that some people with diabetes also have peripheral arterial disease. Referral for vascular assessment may be appropriate before recommending compression garments.”

In addition to regular foot checks, patients can minimise their risk of diabetes-related foot problems by having daily foot inspections, maintaining a balanced diet, and staying active to manage blood sugar levels, says Mr Najran.

He says patients can be advised to seek help to quit smoking, to strive to keep blood sugar levels as close to target as possible, to monitor blood pressure, support lipid lowering therapies and to regularly discuss with healthcare providers to ensure comprehensive diabetes management.

To enhance the visibility and effectiveness of the foot and leg care section in a pharmacy through effective category management, pharmacists should ensure that staff are trained to provide informative consultations, focusing on individual patient needs and concerns, says Mr Najran.

Pharmacists should regularly update clinical knowledge on diabetic foot care and related conditions through workshops, seminars, and professional courses, he says.

They can "highlight specialised training and expertise in marketing materials, showing patients they can trust the pharmacy for their foot care needs”, he says.

He advises strategically positioning foot and leg care products in high-traffic areas of the pharmacy to attract attention with information of diabetic foot reviews that can be offered.

Pharmacists can use clear signage and educational materials to inform patients about the importance of foot care and available products, he says.

They can also use community health events to demonstrate the pharmacy's role in diabetes management, offering  support on daily foot inspections and educational sessions, he says.

He says the foot and leg care market is experiencing “innovative developments that pharmacies can leverage to enhance their offerings and support diabetic patients effectively”. Some key trends and innovations include smart socks equipped with sensors to measure friction and provide real-time foot pressure feedback, significantly reducing the incidence of diabetic foot ulcers by over 70 per cent.² 

Pharmacies can collaborate with local 3D printing services

“Pharmacists can promote these products as part of a preventative care strategy,” says Mr Najran. 

Using 3D printing technology to create custom footwear that supports proper foot alignment and comfort can be “a game changer”, says Mr Najran. “Pharmacies can collaborate with local 3D printing services to offer bespoke footwear options tailored to individual patient needs.”

As consumers become more environmentally conscious, pharmacies can offer sustainable foot care products and packaging, he says. "This could include biodegradable materials or products made from recycled components, appealing to a growing market segment."

Offering virtual services for foot care consultations “can make it easier for patients to receive guidance without the need for in-person visits, especially beneficial for those with mobility issues or time constraints”.  However virtual consultations can be restricted and ideally should be used in combination with face to face reviews, he says.

Mr Najran advises pharmacists to “reach out to your local Integrated Care Board (ICB) and multidisciplinary teams (MDTs) to explore opportunities for pharmacists to enhance support for diabetic patients within the community”.  

They can also consider shadowing local foot clinics or specialists to gain hands-on experience, to enhance their competency and confidence in managing patients effectively, he says.

And they can "foster relationships with healthcare professionals in their community to ensure a cohesive approach to patient care, ultimately leading to improved health outcomes for those at risk of diabetic foot complications”, he says.

“By taking these steps, pharmacists can significantly contribute to the prevention and management of diabetic foot issues, enhancing patient care and overall health within the community.”

References

1. National Institute for Health and Care Excellence (NICE) (published 2015, updated 2019) Diabetic foot problems: prevention and management. NICE guideline NG19. https://www.nice.org.uk/guidance/ng19  

2. Diabetes Research & Wellness Foundation (2026) Stress-measuring smartwear in diabetes foot care is a “sock-sess” story. https://www.drwf.org.uk/news-and-events/news/stress-measuring-smartwear-in-diabetes-foot-care-is-a-sock-cess-story/