Boyko et al developed a score for predicting the risk of a diabetic developing a foot ulcer. This can help identify a patient who may benefit from more aggressive management. The authors are from the Veterans Administration Pugent Sound Health Care System and University of Washington in Seattle.
Parameters:
(1) hemoglobin A1C in percent (as a whole number)
(2) neuropathy
(3) vision
(4) tinea pedis
(5) onychomycosis
(6) past history of foot ulcer (either side)
(7) past history of lower limb amputation (either side)
Parameter |
Finding |
Points |
---|---|---|
neuropathy |
absent |
0 |
|
present |
1 |
vision |
good to fair |
0 |
|
poor |
1 |
tinea pedis |
absent |
0 |
|
present |
1 |
onychomycosis |
absent |
0 |
|
present |
1 |
history of foot ulcer |
absent |
0 |
|
present |
1 |
history of lower limb amputation |
absent |
0 |
|
present |
1 |
where:
• The score uses hemoglobin A1C results over the entire range (normal and elevated). It would be interesting to see if the degree of elevation above normal was used.
total score =
= (0.0975 * (percent hemoglobin A1C)) + (0.7101 * (points for neuropathy)) + (0.3888 * (points for vision)) - (0.3206 * (points for tinea pedis)) + (0.4579 * (points for onychomycosis)) + (0.7784 * (points for history of foot ulcer)) + (0.943 * (points for amputation))
Interpretation:
• minimum score: varies with hemoglobin A1C, but close to 0
• maximum score: around 5.1
• The higher the score the greater the risk of diabetic foot ulcer.
Total Score |
10 Year Risk |
<= 1.47 |
12% |
1.48 to 1.99 |
26% |
2.00 to 2.61 |
38% |
2.62 to 5.07 |
65% |
Purpose: To evaluate a diabetic patient for risk of foot ulcer using the model of Boyko et al.
Specialty: Dermatology, Endocrinology, Surgery, general, Surgery, orthopedic
Objective: risk factors
ICD-10: E10, L97,