Why Neurovascular Assessments Are Essential in Podiatry— and why they should be done routinely for everyone
In podiatry, neurovascular assessments are one of the most important tools we have for protecting long-term foot health. They assess blood supply (vascular status) and nerve function (neurological status) in the feet—two systems that are fundamental to healing, sensation, balance, and mobility.
Despite their importance, neurovascular checks are often perceived as something only required for people with diabetes or Peripheral Arterial Disease (PAD). Current clinical evidence and international guidelines demonstrate that this approach is too narrow.
Routine neurovascular assessment should form part of a comprehensive foot assessment for all patients, regardless of age, diagnosis, or presenting complaint.
Many foot health problems develop silently
Vascular and neurological disease often progress without early or obvious symptoms:
Reduced blood flow may not cause pain until disease is advanced
Nerve damage can develop long before numbness or altered sensation is noticed
Patients frequently adapt unknowingly to gradual changes in circulation or sensation
Research consistently shows that loss of protective sensation and impaired blood supply are two of the strongest predictors of foot ulceration and amputation. Early identification through routine assessment significantly reduces the risk of serious complications.
Neurovascular assessment allows podiatrists to detect subtle early changes, often before patients are aware of a problem, enabling timely intervention and prevention.
Foot problems behave differently depending on neurovascular health
Even seemingly minor foot conditions—such as callus, corns, nail pathology, fissures, or heel pain—can behave very differently depending on circulation and nerve function.
For example:
Small skin breaks may fail to heal if blood supply is compromised
Reduced sensation increases the risk of pressure damage going unnoticed
Healing following routine podiatry treatment may be delayed where perfusion is reduced
Clinical evidence shows that neurovascular compromise alters tissue tolerance and healing capacity, meaning that assessment is essential for safe and appropriate treatment planning.
Neurovascular risk is not static
Neurovascular status changes over time and may deteriorate due to:
Ageing
Smoking history
Hypertension or hypercholesterolaemia
Medication changes
Reduced mobility or systemic illness
A patient considered low risk at one appointment may not remain so indefinitely. Routine assessment allows Podiatrists to monitor trends over time, modify care safely, and escalate concerns promptly when risk increases.
Conditions that benefit from routine neurovascular assessment
Neurovascular compromise is not limited to diabetes or PAD. Many medical conditions, treatments, and lifestyle factors can affect blood flow and nerve function in the feet.
Cardiovascular disease and vascular risk factors
Patients with hypertension, hyperlipidaemia, or a history of heart attack or stroke often have systemic vascular disease that can affect the lower limbs. Neurovascular assessment helps identify reduced perfusion early, even when patients are asymptomatic.
Smoking (current or previous)
Smoking is one of the strongest modifiable risk factors for vascular disease. Long-term circulatory damage may persist even after smoking cessation, making routine vascular assessment essential.
Autoimmune and inflammatory conditions
Conditions such as rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s syndrome, and vasculitis are associated with peripheral neuropathy and vascular involvement. Neurological assessment is therefore important even in patients without diabetes.
Chronic kidney disease (CKD)
People with CKD—particularly those with advanced disease or on dialysis—are at significantly increased risk of:
Vascular calcification
Peripheral neuropathy
Delayed wound healing
Foot ulceration and amputation
Foot risk in this group is frequently under-recognised, making routine neurovascular assessment particularly important.
Neurological conditions
Conditions such as stroke, Parkinson’s disease, multiple sclerosis, and spinal nerve compression can alter sensation, balance, and protective feedback. Neurovascular assessment helps differentiate neurological change from vascular compromise and supports appropriate referral.
Cancer treatment (past or present)
Chemotherapy and radiotherapy are recognised causes of peripheral neuropathy, vascular changes, and skin fragility. Regular assessment allows podiatrists to adapt care safely and reduce the risk of injury.
Older adults and reduced mobility
Ageing naturally affects circulation, nerve conduction, and skin resilience. When combined with reduced mobility, the risk of unnoticed injury and delayed healing increases—even in the absence of a formal diagnosis.
Higher importance for people with diabetes and PAD
While neurovascular assessment is important for everyone, it is critically important for those with diabetes and/or Peripheral Arterial Disease.
Diabetes
Diabetes significantly increases the risk of:
Peripheral neuropathy (loss of protective sensation)
Poor wound healing
Infection
Rapid progression from minor injury to ulceration
International guidelines strongly recommend regular neurological and vascular screening as part of routine diabetic foot care to reduce the risk of ulceration and amputation.
Peripheral Arterial Disease (PAD)
PAD reduces blood flow to the feet and may be asymptomatic until advanced. Reduced perfusion significantly increases the risk of non-healing wounds, infection, and limb-threatening complications.
Routine neurovascular assessment is essential to:
Monitor disease progression
Assess healing potential
Identify the need for urgent referral
Prevent critical limb ischaemia
Safer, more personalised podiatry care
Neurovascular assessment directly informs clinical decision-making, helping Podiatrists determine:
How much tissue reduction can be carried out safely
Whether pressure redistribution or offloading is required
Appropriate footwear and self-care advice
When referral to GP, vascular, renal, or specialist services is indicated
This ensures podiatry care is individualised, evidence-based, and safe.
Prevention is always better than treatment
Advanced neurovascular disease is often irreversible, but many serious foot complications are preventable with routine monitoring and early intervention.
Regular neurovascular assessment supports:
Preservation of mobility
Maintenance of independence
Reduction in long-term complications
Improved quality of life
Neurovascular assessment is not just about managing known disease — it is about identifying risk early and preventing harm before serious problems develop.
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American Diabetes Association. (2025). Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes—2025. Diabetes Care, 48(Suppl. 1), S252–S263.
International Working Group on the Diabetic Foot (IWGDF). (2024). Practical guidelines on the prevention and management of diabetes-related foot disease. Diabetes/Metabolism Research and Reviews.
Bus, S. A., et al. (2024). Guidelines on the prevention of foot ulcers in persons with diabetes. Diabetes/Metabolism Research and Reviews, e3657.
Parveen, K., et al. (2025). Neurovascular complications and risk factors in diabetic foot ulcer development. BMC Public Health, 25, 21639.
Houghton, J. M., et al. (2025). Effectiveness of evidence-based foot screening tools for early identification of diabetic foot risk. The Foot, 52, 101960.
Lichtenberg, M., et al. (2024). Peripheral arterial disease and diabetic foot syndrome: pathophysiology and clinical implications. Journal of Clinical Medicine, 13(7), 2141.
Game, F. (2025). The diabetic foot and renal disease. ABCD–UK Kidney Association Joint Meeting.
De Souza, J. M., et al. (2023). Peripheral neuropathy in systemic autoimmune rheumatic diseases: diagnosis and management. Frontiers in Medicine.
The information provided in this article is based on current clinical guidelines, peer-reviewed medical literature, and established best practice within podiatry and foot health care. It is intended for general educational purposes and does not replace individual clinical assessment, diagnosis, or personalised medical advice. Neurovascular assessment findings are always interpreted in the context of the individual patient, their medical history, and presenting risk factors.
