The Description and Classification of Diabetic Foot Lesions

Abstract

Diabetic foot ulcers are of many types and different ulcers require management in different ways. Their optimal management is currently hindered by lack of a useful working classification. Such a classification must be flexible enough to be applied to all lesions likely to be encountered but specific enough to enable clear definition of an individual lesion. It must also be simple enough to ensure that it is understood by all categories of health care workers, whether specialist or not. An attempt has been made to devise a classification--based on the key elements used in describing foot lesions--and it is put forward to act as stimulus for debate. It is based on the clinical definition of infection, ischaemia, and neuropathy. Although two of these, or even all three, may be found in the same foot, they should be considered in the order given because this reflects the sequence of clinical decisions which should be made. The adoption of a classification such as this would aid education, communication, research and audit, and would lead to better management of ulcers.

Diabetic foot syndrome: Immune-inflammatory features as possible cardiovascular markers in diabetes

“…Among diabetic vascular complications, foot ulcers represents the first cause of hospitalization in diabetics and a significant cause of health care costs (more than 20%-40% of health care resources have been reported as related to diabetes-related foot care) [1,2] . According World Health Organization, its' possible encompass all foot complications in the term diabetic foot syndrome (DFS) that has been defined as "ulceration of the foot (distally from the ankle and including the ankle) associated with neuropathy and different grades of ischemia and infection" [3] . More than 80000 amputations directly related to diabetes have been registrated in the United States annually [4] and the majority (80%) of these have been performed in patients with a previous foot ulceration [5] .…”

A Comparison of Two Diabetic Foot Ulcer Classification Systems

“…It seems that poor clinical outcomes are generally associated with infection, peripheral vascular disease, and increasing wound depth; it also appears that the progressive cumulative effect of these comorbidities contributes to a greater likelihood of a diabetic foot ulcer leading to a lower-limb amputation. An easy-to-use classification system that provides a uniform description of an ulcer (including depth and presence of infection and ischemia) (19) will help in planning treatment strategies and predicting outcomes in terms of healing and lower-limb amputations.…”

The Place of Sensory Neuropathy in the Pathogenesis of Critical Limb Ischemia in Diabetic Patients

“…But pathogenesis of DFS depends on many factors and in some cases DPN could be subclinical or even absent, associated or not with severe microcirculation disorders or other factors. This is important because knowledge of role of different cause's combinations could help earlier diagnosis and improve control of diabetes related complications [3].Objective: The aim of the current study was to examine the correlation between neuropathy and clinical features of DFS in subjects with type 2 diabetes.Materials and methods. In total 47 patients aged 43-82 years (mean age -64,7±1,3 years, 66,0 % men and 34,0 % women) were involved in the study.…”

“…But pathogenesis of DFS depends on many factors and in some cases DPN could be subclinical or even absent, associated or not with severe microcirculation disorders or other factors. This is important because knowledge of role of different cause's combinations could help earlier diagnosis and improve control of diabetes related complications [3].…”

“…One of the main causes of diabetic complications is a decrease of blood supply as a result of vascular pathology on both levels -macroand microcirculation. Complications of feet are the most frequent problems of diabetes and key contributors to the medical and financial implicationsas nearly half of all hospitalizations due to diabetes are the feet complications [2,3]. The diabetic foot syndrome (DFS) is defined, according to the WHO, as "ulceration of the foot associated with neuropathy and different grades of ischemia and infection" [3].…”