Assessing and managing diabetic foot ulcers


It has been suggested that 85% of diabetic foot amputations
might be avoided with timely detection and appropriate management of skin ulcers.1

Classifying diabetic food ulcers Key considerations for management


Patients with a diabetic foot ulcer should have the ulcer characteristics measured (such as size, depth, appearance and location) and the aetiology of the ulcer determined (neuropathic, ischaemic or neuroischaemic).2

Debridement of the ulcer is usually required to remove all necrotic tissue and surrounding callus BEFORE the ulcer is assessed.1


A diabetic foot lesion should never be regarded as trivial

until it is healed and has remained healed for at least a month.


Wagner ulcer classification system4


Wound control in the neuropathic and neuroischaemic ulcer is based upon a multidisciplinary approach and a comprehensive protocol that addresses all aspects of the diabetic patient's needs.


Every break of the skin in the diabetic foot is a

portal of entry for bacteria and has the potential for disaster.


The aim is to heal ulcers within the first 6 weeks of their development.

This is the time for aggressive management and is a window of opportunity that should be taken seriously.



The grade 0 foot has intact skin. It has been found that this is the greatest protection to the diabetic foot. There may be bony deformities such as bunions, claw toes, depressed metatarsal heads, and Charcot breakdown with bony prominences. There may be hyperkeratic lesions around or under bony deformities.

The grade 1 foot has a superficial ulcer. The base may be necrotic or may be viable with early granulation.

This lesion is deeper and extends to bone, ligament, tendon, joint capsule or deep fascia. There is yet no abscess or osteomyelitis.

Progression of the previous lesions has resulted in a deep abscess, osteitis, or osteomyelitis. The exact extent of the lesion is frequently difficult to determine from superficial examination.

In a grade 4 lesion some portion of the toes or forefoot is gangrenous. The gangrene may be moist or dry.

A grade 5 foot represents such complete involvement that no foot healing or local procedure is possible.

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