Margolis et al. used a classification scheme to grade diabetic neuropathic foot ulcers. This can help stratify patients based on disease severity. 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
Depth of Invasion
Other Findings
Grade
partial thickness (epidermis and dermis)
1
full thickness into subcutaneous tissue
2
exposure of tendon, ligament or joint
3
exposure of tendon, ligament or joint
abscess or osteomyelitis
4
exposure of tendon, ligament or joint
necrotic tissue in the wound
5
exposure of tendon, ligament or joint
gangrene of the limb
6
where:
• This could be modified to include a Grade 0 for skin changes preceding skin breakdown.
• Grade 6 with gangrene of the limb hardly seems like an adequate blood supply.
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