Diabetes-related foot complications are among the most preventable causes of hospitalisation in the NHS. According to Diabetes UK, there are approximately 169 diabetes-related amputations per week in England, and around 80% of these are preceded by a foot ulcer that could have been identified earlier. Community pharmacists, who see patients with diabetes regularly at prescription collection, have an opportunity to support earlier detection and better foot care.
The scale of the problem
An estimated 4.3 million people in the UK are living with diagnosed diabetes, the vast majority with type 2. NICE guideline NG19 (Diabetic Foot Problems: Prevention and Management) recommends that all people with diabetes receive an annual foot assessment to identify those at risk of ulceration. Yet audit data from the National Diabetes Foot Care Audit (NDFA) suggests that a significant proportion of patients do not receive their annual check — particularly those managed entirely in primary care without specialist diabetes team involvement.
The consequences of missed screening are severe. A diabetic foot ulcer that is not identified and managed promptly can progress to infection, gangrene and amputation within weeks. The five-year mortality rate following a major diabetes-related amputation is higher than for most common cancers.
What pharmacists can observe
Pharmacists are not expected to conduct formal diabetic foot assessments — that requires specific training, a monofilament and a Doppler probe. However, pharmacists can play a valuable role in:
Recognising visible warning signs
During routine interactions, pharmacists may observe:
| Sign | What it may indicate |
|---|---|
| Discoloured or blackened toes | Possible ischaemia or gangrene — urgent referral |
| Open sores or ulcers on feet | Active foot ulcer — same-day referral to diabetes foot team |
| Swollen, red, hot foot (especially if one-sided) | Possible Charcot foot or infection — urgent referral |
| Very dry, cracked skin on heels | Increased ulceration risk — foot care advice |
| Changed shoe-wearing patterns or limping | May indicate neuropathy or existing ulcer |
Any pharmacist who observes signs of an active diabetic foot emergency (blackened tissue, spreading redness, new ulceration) should advise the patient to seek same-day assessment, either through their GP diabetes team or through A&E if the GP is not available.
Asking about annual foot checks
A simple question — "Have you had your annual diabetic foot check this year?" — can prompt patients who have missed their screening. The question is particularly valuable for patients who collect prescriptions for metformin, insulin or other diabetes medicines but may not be engaging regularly with their GP practice.
Advising on day-to-day foot care
Practical foot care advice that pharmacists can offer at the counter:
- Inspect feet daily — use a mirror for the soles if flexibility is limited
- Wash feet daily in warm (not hot) water; dry thoroughly between toes
- Moisturise dry skin — but not between the toes, where moisture encourages fungal infection
- Never cut calluses or corns at home — refer to podiatry
- Wear well-fitting shoes — neuropathy means patients may not feel pressure points
- Do not walk barefoot, even indoors
- Check shoes for foreign objects before putting them on — neuropathy means patients may not feel a stone or nail
Footwear and product advice
The pharmacy counter stocks several products relevant to diabetic foot care:
- Emollients: urea-based creams (e.g. Flexitol, CCS) for cracked heels — advise patients to use these daily but avoid between toes
- Antifungal treatments: athlete's foot between the toes is common in diabetes and increases ulceration risk. Standard OTC antifungals (clotrimazole, terbinafine) are appropriate, but pharmacists should advise the patient to see their GP if the infection does not resolve within two weeks
- Wound dressings: for minor cuts, standard adhesive dressings are appropriate, but any wound that does not heal within two weeks warrants GP review
The referral pathway
Pharmacists should be familiar with their local diabetic foot pathway. Most areas in England have a multidisciplinary diabetic foot team (MDFT) that can see urgent referrals within 24 hours. The referral route is typically through the GP, but some areas accept direct referrals from podiatrists and other healthcare professionals.
For non-urgent concerns (dry skin, need for podiatry, missed annual check), the pharmacist can advise the patient to contact their GP practice to arrange a foot assessment and podiatry referral.
Where to explore further
Pharmacists interested in diabetes-related roles can search PharmSee's job listings — one current NHS listing mentions an "Advanced Clinical Pharmacist — Diabetes and Endocrinology" role, reflecting growing pharmacist involvement in specialist diabetes care. The pharmacy search tool allows pharmacists to explore dispensing patterns for diabetes medicines by area, and salary data provides benchmarks for specialist clinical pharmacist positions.
Caveats
The 169-amputations-per-week figure is a Diabetes UK estimate based on Hospital Episode Statistics. The 4.3 million diagnosed diabetes figure is from Diabetes UK's 2024 prevalence data. Pharmacists should exercise clinical judgement when identifying potential foot problems and should refer rather than diagnose. The vacancy data cited is from PharmSee's tracking of 11 public job sources as at 15 April 2026; sample sizes for specialist roles are small.
Sources
- NICE NG19: Diabetic Foot Problems — Prevention and Management (2015, updated 2019)
- Diabetes UK: Diabetes Statistics (2024)
- National Diabetes Foot Care Audit (NDFA), NHS Digital
- PharmSee vacancy database, 1,715 active roles as at 15 April 2026