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

Clinical Manifestation PEDIS Grade IDSA Severity
No symptoms or signs of infection 1 Uninfected
Local infection involving only the skin and the subcutaneous tissue without involvement of deeper tissues and without signs of SIRS 2 Mild
Local infection with erythema >2 cm or involving structures deeper than skin and subcutaneous tissues (eg, abscess, osteomyelitis, septic arthritis, fasciitis) without signs of SIRS 3 Moderate
Local infection with the signs of SIRS, as manifested by ≥2 of the following: 4 Severe


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

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. Wagner, F William (1987). "The Diabetic Foot". Orthopedics. 10 (1): 163–172. doi:10.3928/0147-7447-19870101-28. ISSN 0147-7447.