The University of Texas Staging System for Diabetic Foot ...

[Pages:3]The University of Texas Staging System for Diabetic Foot Ulcers1 with Associated Interventions2

The University of Texas Staging System for Diabetic Foot Ulcers

Stage

A B C D

Grade 0

Pre- or post-ulcerative lesion completely epithelialized Infection

Ischemia

Infection & Ischemia

Grade I

Superficial ulcer, not involving tendon capsule

or bone Infection

Ischemia

Infection & Ischemia

Grade II

Ulcer penetrating to tendon or capsule

Infection Ischemia Infection & Ischemia

Score: Grade______ Stage_____

Grade III

Ulcer penetrating to bone or joint Infection Ischemia

Infection & Ischemia

Suggested Interventions

Stage A

Education including advise on appropriate footwear [see the South West Regional Wound Care Program's (SWRWCP) patient pamphlet, "My Diabetic Foot Ulcer"

Assessment of the person by a specialist physician every one-two months o Neurovascular status, i.e. palpation of pedal pulses, 10g monofilament testing o Dermal thermometry o Inspection of feet and footwear o Yearly dynamic plantar pressure updates

 Foot offloading (if ulcer on the plantar aspect of the foot) Consider need for prophylactic surgery re bony deformities Digital imaging to rule our osteomyelitis if bone is visible/palpable and osteomyelitis is suspected Wound/patient assessment and management as per the SWRWCP guidelines:

o "Guideline: The Assessment of People with Diabetic/Neuropathic Foot Ulcers" o "Guideline: The Management of People with Diabetic/Neuropathic Foot Ulcers"

Stage B

Same interventions as Stage A PLUS: o Debridement of infected bone/tissue as indicated o Medical management of infection, i.e. topical +/- systemic antimicrobials depending on the severity of the infection (NOTE: this may require hospitalization depending on the severity of the infection) o NOTE: total contact casting is contraindicated until there is evidence that the wound infection is responding to medical interventions

Stage C

Same interventions as Stage A PLUS: o Prompt vascular consultation re possible revascularization o NOTE: total contact casting is contraindicated in those with a dysvascular foot

Stage D

Same interventions as Stage C PLUS: o Debridement of infected bone/tissue o Medical management of infection, i.e. antibiotics (NOTE: this may require hospitalization depending on the severity of the infection)

o NOTE: Debridement and medical management of limb threatening infection/sepsis must take place prior to revascularization attempts

References 1 Armstrong D, Lavery LA, Harkless LB. Validation of a diabetic wound classification system: The contribution of depth, infection and ischemia

to risk of amputation. Diabetes Care. 1998;21(5):855-859. 2 Armstrong D, Lavery LA, Harkless LB. Treatment-based classification system for assessment and care of diabetic feet. Journal of the

American Podiatric Medical Association. 1996;86(7):311-316.

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