Deformity: how podiatrists assess this for the diabetic foot assessment

Background: Foot deformity is a key risk factor for diabetic foot ulcer risk assessment in UK-based screening tools. Research and guidelines on ulcer risk vary in how deformity is defined or assessed. Anecdotally, foot deformity assessments can be inconsistent in practice. Aims: To understand how podiatrists assess deformity, difficulties experienced and what, if any, improvements to guidance clinicians want. Methods: Mixed method
study with 26 participants from one NHS Trust completing an online survey and four participants completing a 1:1 interview. Results: Over half of respondents reported difficulty in assessing deformity, particularly where deformity is slight. Opposing
views emerged on what constitutes “normal” foot shape. Guidance was felt to be lacking, particularly on the roles of severity of deformity, biomechanics and footwear. Conclusion: Significant variation exists in clinicians’ view of deformity and how it
should be assessed. Improved guidance would be welcomed but concerns were expressed regarding curtailment of clinical judgement.