Your annual foot check: what they are testing for, and what your risk level means
What happens at the check, what low, moderate and high risk each entitle you to, and the foot symptoms that need reporting the same day.
The annual foot check is a screening test that ends in a result you should be told out loud. Someone examines both bare feet, tests whether the nerves still pass on sensation, checks the blood supply, and gives you a risk level.
- They test feeling, with a nylon thread called a monofilament and a tuning fork, and blood supply, by feeling for pulses or with a handheld doppler.
- The result is low, moderate or high risk, or an active foot problem that needs treating now.
- Moderate or high means a referral to the foot protection service, a podiatry-led team, with a waiting time attached.
- It happens while your feet feel fine because lost sensation is not something you notice from the inside.
- Between checks the job is yours: a daily look, and changes that need a call within 24 hours.
Why they check feet that feel completely normal
Lost sensation is invisible from the inside. Nerves do not send a message to say they have stopped sending messages, so the first sign is often something you see rather than something you feel: a blister that never hurt, a cut nobody can date.
The check looks at two systems that fail in different ways. Nerves carry sensation, arteries carry the blood that heals a small wound, and you can have a problem with one and not the other. That is why both get tested, and why they want shoes, socks and any dressings off both feet rather than just the one you mentioned. It starts early, too: NICE says foot risk should be assessed when diabetes is diagnosed rather than years later, and between 12 and 17 the foot assessment forms part of the annual assessment with the paediatric or transition team.
What low, moderate and high risk are based on
The four levels are lists of findings, not verdicts on you. Low risk means nothing was found, or hard skin (callus) and nothing else. Moderate risk means one of three things: a change in the shape of your foot, nerve damage (neuropathy), or narrowed arteries reducing the blood supply, which is called peripheral arterial disease.
High risk means a previous ulcer or amputation, kidney replacement treatment such as dialysis, nerve damage and reduced blood supply together, or either of those alongside callus or a change in foot shape. An active foot problem sits outside the scale: an ulcer, an infection, gangrene, a limb-threatening loss of blood supply, or a suspected acute Charcot foot, where bones in a numb foot weaken and the shape can change. That gets treated now rather than filed as a risk level.
What your risk level entitles you to
Low risk means the check comes round again and nothing else changes. Moderate and high risk both mean a referral to the foot protection service, and NICE puts times on it: assessed within 6 to 8 weeks at moderate risk, within 2 to 4 weeks at high risk. If you were told you are moderate or high risk and no appointment arrived, that is a fair thing to chase.
Reassessment then follows the level: about once a year at low risk, every 3 to 6 months at moderate risk, every 1 to 2 months at high risk, and every 1 to 2 weeks at high risk when something is being watched right now. An active foot problem skips all of that: referral within one working day, and straight to hospital when it is limb-threatening or life-threatening.
What nerve damage feels like, and the daily look
Peripheral neuropathy is nerve damage in the feet and legs, and diabetes is its most common cause in the UK. Years of high glucose can damage the small blood vessels that feed those nerves. It shows up as numbness and tingling, burning or shooting pain that is often worse at night, and losing the ability to feel pain or a change in temperature. Some get pain with no numbness, some numbness with no pain, and either is worth reporting rather than saving for the next check.
Your half is a look, twice a day if you can: before your socks go on and before bed, tops, soles, heels and between the toes, with a mirror on the floor, or someone else’s eyes, if you cannot see the soles. Check inside your shoes for a stone or anything sharp through the sole. Corn plasters, corn creams and blades on hard skin can burn or cut the skin and start an ulcer, so hard skin and awkward nails belong to a podiatrist. Emollient cream stops skin cracking, though never between the toes, and bath water gets tested with a wrist or elbow first.
What changes how often you are seen
How often it comes round is not the same for everyone. NICE says risk should be assessed at diagnosis and at least once a year after that, and the NHS says a foot check at least once a year. The variation sits at the low-risk end: Diabetes UK says a low-risk check may move to every other year, and in Scotland low-risk foot screening has moved to every two years, a change made by the Scottish Diabetes Foot Action Group. Moderate and high risk go the other way, seen more often rather than less. If a year has gone by and nobody has asked to see your bare feet, ask.
What this looks like in practice
Examples, not instructions or doses.
Someone presses a thin nylon thread against several spots on your soles and asks you to say when you feel it. You miss two on the right foot and had no idea. Nothing hurts, nothing looks wrong, and that quiet result is the whole reason the test exists.
New shoes, a rubbed heel, and a blister that would normally be sore and simply is not. Painless is not reassuring here: it is the detail that makes it a call to your foot team or GP within 24 hours.
One foot is red, warm and puffy, the skin is unbroken, and you assume you twisted something. Where there is nerve damage, that picture can be an acute Charcot foot, which should be seen within a working day. Worth the same-day call even with nothing to show.
It has been eighteen months since anyone asked to see your bare feet. There is nothing to explain and nobody to apologise to: ring the surgery or your diabetes clinic, say you are due a foot check, and ask what your last risk level was.
Worth a phone call rather than a wait
Questions that make an appointment useful
When it's urgent
A foot infection can turn into sepsis, and that means 999 or A&E straight away, not a call to the surgery in the morning. Go now for confusion or slurred speech, blue, grey, pale or blotchy skin, lips or tongue, a rash that does not fade when a glass is rolled over it, fast or difficult breathing, a high temperature, or a heart beating much faster than usual.
An infection can also bring on DKA (diabetic ketoacidosis, when a shortage of insulin makes the body burn fat and produce ketones). Being sick, stomach pain, deep or fast breathing, fruity-smelling breath, drowsiness or confusion alongside high glucose also mean 999 or A&E straight away, and testing ketones must never delay the call. If you feel unwell with high glucose but none of those signs, check ketones if you can and ring your diabetes team or NHS 111.