Podiatry Diabetic Foot-Care Recall: 6.1% Response on 240 At-Risk Patients

The challenge

Greenfield Podiatry's owner-DPM had a clinically uncomfortable EMR finding: 240 of his ~720 diabetic patients had not had a protective foot exam in over 12 months. Diabetic foot-care guidelines call for at least annual screening, and the practice's referral relationships with primary-care physicians depended on the practice closing this loop. The owner suspected several of these patients had migrated to walk-in clinics or pharmacy-based diabetic services — losing the relationship completely.

Reactivation was clinically and ethically charged. These weren't lapsed cosmetic patients; they were patients with a chronic condition where missed exams correlate with higher rates of ulceration, hospitalization, and amputation. Promotional framing was inappropriate. But the standard EMR email reminder had clearly not worked — bookings from it tracked under 8 per quarter from this segment.

The owner-DPM also faced a reimbursement reality: diabetic foot exams are insurance-paid but at modest rates ($170-$220 per visit). Campaign math has to be conservative — this isn't an aesthetic-derm $4,000 ticket category. The campaign needed to be cost-disciplined to clear ROI even with realistic response and modest visit values.

The PostKnock approach

Playbook used: Diabetic Foot Care Recall

We deployed PostKnock's Diabetic Foot Care Recall playbook with copy reviewed personally by the owner-DPM for clinical accuracy. The 240-patient list was segmented by risk: high-risk (prior ulcer, neuropathy flag, or 2+ year gap, 80 patients), moderate-risk (peripheral neuropathy without prior ulcer, 100), and standard diabetic recall (60).

Wave 1 was a 6x9 postcard with a clinical headline ("Your protective foot exam is due") and a copy block that referenced both the patient's last visit and the role of the practice's exam in the patient's overall diabetic care plan. The card was deliberately monochromatic and serif-typed, designed to read as a clinical communication. It included QR booking and a callback line. The high-risk segment received a slightly different version with explicit language about ulceration risk approved by the DPM.

Three days after Wave 1, the medical assistant worked through the high-risk non-responder list with a script the DPM wrote: "Dr. Chen wanted me to reach out personally — your last protective foot exam was [date] and we'd like to get you in." Wave 2 dropped at week 5 to non-responders only, with a different creative emphasizing the practice's coordination with the patient's PCP. Total: 380 pieces, ~95 outbound calls, 8-week campaign.

Campaign timeline

Week 0

EMR export, 3-tier risk segmentation, DPM copy review.

Week 1

Wave 1 drops (240 cards). High-risk segment gets explicit risk language.

Week 2

MA runs high-risk follow-up calls. 75 dials, 38 connects, 6 schedule on call.

Week 3-4

Bookings flow. 9 protective foot exams scheduled.

Week 5

Wave 2 drops (~140 cards) to non-responders. PCP-coordination angle.

Week 6-7

Tail bookings. 6 incremental visits.

Week 8

Final tally: 15 visits booked. Two ulcer flags caught early.

Results

Fifteen booked protective foot exams across 240 unique patients — 6.1% response, on the high end of the 3-6% healthcare recall range, reflecting the personal MA-led call follow-up that was clinically appropriate for this population. Average visit value $340 (the protective exam plus typical adjuncts: callus debridement, orthotic check, sensation testing) for $5,100 in directly-attributable revenue.

Campaign cost ran $2,700 — $228 in postcards (380 at $0.60), $297 in Pro plan, and $2,175 in MA labor for the call follow-up. ROI of 1.9x on first-visit visible revenue is honest — diabetic foot-care isn't a high-ticket category. But the strategic value comes through in the tail: two of the 15 visits caught early ulceration flags that would have escalated to hospitalization within 60-90 days, the practice's PCP referral relationships strengthened, and 11 of the 15 patients are now on a 6-month recurring cadence. Year-2 ROI on this cohort projects to 4.2x.

“I almost didn't run this because the ROI math looked thin. The two patients we caught with early ulceration didn't show up in the campaign report — but they're why I'll run it every quarter.”

— Owner-Podiatrist, Greenfield Podiatry (composite illustration)

What we’d do differently

• Risk-tier segmentation is the difference between a financially-marginal campaign and a clinically-meaningful one. We'd shrink the standard-risk mailing volume next time and put the saved budget toward longer Wave 2 follow-up on high-risk.
• MA-led calls outperformed admin-led calls in this segment. Patients responded to a clinical voice. The DPM is now considering making this a standing weekly task.
• We should have asked the EMR vendor to add a "protective exam due date" field on the postcard's QR booking page — three patients reported confusion about whether the visit would be covered. Friction we can engineer out next time.