Margolis et al evaluated the healing rate of diabetic neuropathic foot ulcers treated with standard treatment regimens (without use of growth factors). The authors are from the University of Pennsylvania in Philadelphia.
The diagnosis of diabetic neuropathic foot ulceration requires:
(1) diabetes mellitus
(2) lack of protective sensation (neuropathy)
(3) adequate arterial blood flow to the foot
Standard treatment:
(1) debridement of necrotic tissue (if present)
(2) moist dressing
(3) some device to protect the foot from injury
Time interval to determine healing: 20 weeks
Parameters:
(1) area of the ulcer
(2) duration prior to presentation
(3) ulcer grade (after Margolis et al)
Parameter
Finding
Points
area of ulcer
<= 2 square centimeters
0
> 2 square cm
1
duration of ulcer
<= 2 months
0
> 2 months
1
ulcer grade
1 or 2
0
>= 3
1
where:
• To have an area of 2 square cm the diameter of the ulcer has to be 1.6 cm, assuming a circular ulcer.
total risk score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
• The higher the score, the less likely the ulcer will heal using a standard treatment regimen.
Risk Score
Not Healed at 20 Weeks
0
34% (a third)
1
48% (half)
2
67% (two thirds)
3
78-81% (four fifths)
from Table 3, page 629
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