Diabetic foot classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Daniel A. Gerber, M.D. [2] Anahita Deylamsalehi, M.D.[3]
Overview
Diabetic foot is classified based on ulcer's features in order to assist with clinical decision-making regarding the need for oral or parenteral antibiotics, outpatient management, hospitalization, and surgical intervention. There are multiple methods of classification for diabetic foot. One of them that has been published by The Infectious Disease Society of America (IDSA) in their 2004 guideline and mainly has been focused on the extent of infection and inflammation of the ulcer. In addition another similar classification system has been released by The International Working Group on the Diabetic Foot (IWGDF) in 2012. The aforementioned systems were externally validated in a longitudinal study to assess prognostic value, which demonstrated increased risk for amputation among patients with infections classified as severe. Another widely accepted diabetic foot ulcer classification is Wagner ulcer classification system, which uses some ulcer's features such as depth, in addition to presence of osteomyelitis or gangrene.
Classification
- Diabetic foot infections are classified according to the severity of involvement to assist with clinical decision-making regarding the need for oral or parenteral antibiotics, outpatient management, need for hospitalization, and surgical intervention.[1]
- The Infectious Disease Society of America (IDSA) introduced a classification scheme for these infections in their 2004 guidelines, broadly categorized as mild, moderate, and severe infections based upon the extent of infection and inflammation.[2]
- The International Working Group on the Diabetic Foot (IWGDF) published a similar classification system in 2012.[3]
- The aforementioned systems were externally validated in a longitudinal study to assess prognostic value, which demonstrated increased risk for amputation among patients with infections classified as severe.[4]
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- Another widely accepted diabetic foot ulcer classification is Wagner ulcer classification system, which uses some ulcer's features such as depth, in addition to presence of osteomyelitis or gangrene.[5]
| Grade | Ulcer's Features |
|---|---|
| 0 | Not an obvious open lesion |
| 1 | Superficial ulcer with partial or full-thickness |
| 2 | Extension of ulcer to other structures such as tendon, ligament, joint capsule, or deep fascia (without abscesses or osteomyelitis) |
| 3 | Extension of ulcer to other structures such as tendon, ligament, joint capsule, or deep fascia with abscesses, osteomyelitis or septic arthritis |
| 4 | Presence of gangrene, but localized to forefoot or heel |
| 5 | Presence of extensive gangrene |
References
- ↑ Dinker R Pai, Simerjit Singh (2013). "Diabetic Foot Ulcer – Diagnosis and Management". Clinical Research on Foot & Ankle. 01 (03). doi:10.4172/2329-910X.1000120. ISSN 2329-910X.
- ↑ Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG; et al. (2012). "2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections". Clin Infect Dis. 54 (12): e132–73. doi:10.1093/cid/cis346. PMID 22619242.
- ↑ Lipsky BA, Peters EJ, Senneville E, Berendt AR, Embil JM, Lavery LA, Urbancic-Rovan V, Jeffcoate WJ (2012). "Expert opinion on the management of infections in the diabetic foot". Diabetes Metab Res Rev. 28 (1): 163–78. PMID 22271739.
- ↑ Lavery LA, Armstrong DG, Murdoch DP, Peters EJ, Lipsky BA (2007). "Validation of the Infectious Diseases Society of America's diabetic foot infection classification system". Clin Infect Dis. 44 (4): 562–5. PMID 17243061.
- ↑ Wagner, F William (1987). "The Diabetic Foot". Orthopedics. 10 (1): 163–172. doi:10.3928/0147-7447-19870101-28. ISSN 0147-7447.