Skip to main content

Evidence to Improve Care

Diabetic Foot Ulcers

Care for Patients in All Settings

Click below to see a list of brief quality statements and scroll down for more information.​​


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence.

See below for the quality statements and click for more detail.​


Quality Statement 1: Risk Assessment
People with diabetes are assessed for their risk of developing a diabetic foot ulcer when they are diagnosed with diabetes and at least once a year thereafter. Patients at higher risk are assessed more frequently. All risk assessments are performed using standard, validated tools.


Quality Statement 2: Patient Education and Self-Management
People with diabetes and their families or caregivers are offered education about diabetic foot care and complications, including basic foot care; how to prevent foot complications and monitor for the signs and symptoms of foot complications; and who to contact in the event of a concerning change.


Quality Statement 3: Referral to an Interprofessional Team
le with a diabetic foot ulcer are referred to an interprofessional team that delivers ongoing, coordinated, integrated care. If they have major complications, they are seen within 24 hours by a team that delivers emergency services and then referred to an interprofessional team for ongoing care.


Quality Statement 4: Comprehensive Assessment
People with a diabetic foot ulcer or foot complications undergo a comprehensive assessment that informs their individualized care plan and includes evaluation of vascular status, the presence of infection, and pressure redistribution to determine the healing potential of the wound.


Quality Statement 5: Individualized Care Plan
People with a diabetic foot ulcer or foot complications have a mutually agreed-upon individualized care plan that identifies patient-centred concerns and is reviewed and updated regularly.


Quality Statement 6: Pressure Redistribution
People with a diabetic foot ulcer or foot complications are offered pressure-redistribution devices as part of their individualized care plan.


Quality Statement 7: Wound Debridement
People with a diabetic foot ulcer have their wound debrided if it is determined as necessary in their assessment, and if it is not contraindicated. Debridement is carried out by a trained health care professional using an appropriate method.


Quality Statement 8: Local Infection Management
People with a diabetic foot ulcer and a local infection receive appropriate treatment, including antimicrobial and non-antimicrobial interventions.


Quality Statement 9: Deep/Surrounding Tissue Infection or Systemic Infection Management
People with a diabetic foot ulcer and a suspected deep/surrounding tissue infection or systemic infection receive urgent assessment (within 24 hours of initiation of care) and systemic antimicrobial treatment.


Quality Statement 10: Wound Moisture Management
People with a diabetic foot ulcer receive wound care that maintains the appropriate moisture balance or moisture reduction in the wound bed.


Quality Statement 11: Health Care Provider Training and Education
People who have developed or are at risk of developing a diabetic foot ulcer or foot complications receive care from health care providers with training and education in the assessment and management of diabetic foot ulcers and foot complications.


Quality Statement 12: Transitions in Care
People with a diabetic foot ulcer or foot complications who transition between care settings have a team or provider who is accountable for coordination and communication to ensure the effective transfer of information related to their care.

9

Deep/Surrounding Tissue Infection or Systemic Infection Management

People with a diabetic foot ulcer and a suspected deep/surrounding tissue infection or systemic infection receive urgent assessment (within 24 hours of initiation of care) and systemic antimicrobial treatment.


People with diabetes are more susceptible to infection (over half will develop a skin and soft-tissue infection), and older individuals with diabetes may be at an even higher risk if they have comorbidities, which can mask the severity of the infection. Deep/surrounding or systemic infection may be suspected when three or more of the following signs and symptoms are present: increased ulcer size; elevated temperature in the peri-wound; ability to probe to bone or the presence of exposed bone; new areas of tissue breakdown; presence of red tissue and swelling or edema; increased exudate; and foul odour. Pain is also a sign of deep infection.

For Patients

If you have a suspected deep/surrounding tissue or systemic infection, you should have an urgent assessment within 24 hours and treatment with antibiotics.


For Clinicians

Carry out an assessment within 24 hours and provide systemic antimicrobial treatment for people with a diabetic foot ulcer and suspected deep/surrounding tissue infection or systemic infection.


For Health Services

Ensure that systems, processes, and resources are in place to support clinicians in treating people with a diabetic foot ulcer and suspected deep/surrounding tissue infection or systemic infection.

Process Indicators

Percentage of people with a diabetic foot ulcer and a suspected deep/surrounding tissue infection who receive an assessment within 24 hours of initiation of care

  • Denominator: number of people with a diabetic foot ulcer and a suspected deep/surrounding tissue infection
  • Numerator: number of people in the denominator who receive an assessment within 24 hours of initiation of care
  • Data source: local data collection

Percentage of people with a diabetic foot ulcer and a suspected systemic infection who receive an assessment within 24 hours of initiation of care

  • Denominator: number of people with a diabetic foot ulcer and a suspected systemic infection
  • Numerator: number of people in the denominator who receive an assessment within 24 hours of initiation of care
  • Data source: local data collection

Percentage of people with a diabetic foot ulcer and a confirmed deep/surrounding tissue infection who receive systemic antimicrobial treatment

  • Denominator: number of people with a diabetic foot ulcer and a confirmed deep/surrounding tissue infection
  • Numerator: number of people in the denominator who receive systemic antimicrobial treatment
  • Data source: local data collection

Percentage of people with a diabetic foot ulcer and a confirmed systemic infection who receive systemic antimicrobial treatment

  • Denominator: number of people with a diabetic foot ulcer and a confirmed systemic infection
  • Numerator: number of people in the denominator who receive systemic antimicrobial treatment
  • Data source: local data collection
Deep/surrounding tissue infection

This is characterized as a deeper wound, such as an abscess, osteomyelitis, septic arthritis, or fasciitis.


Systemic infection

This is characterized as a local infection with signs of systemic inflammatory response syndrome.


Systemic antimicrobial treatment

This treatment includes:

  • Broad-spectrum therapy aimed at gram-positive, gram-negative, and anaerobic organisms
  • For osteomyelitis, 6 weeks of antibiotic therapy, which should be initiated based on clinical assessment and if the bone is not resected (1 week of therapy is generally sufficient if the bone is resected)

Let’s make our health system healthier

Join Our Patient, Family and Public Advisors Program

Patients, families and the public are central to improving health quality.


Man smiling

Sign up for our newsletter

Are you passionate about quality health care for all Ontarians? Stay in-the-know about our newest programs, reports and news.

Health Quality Connect - Health Quality Ontario's newsletter - on an iPad and a cell phone