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Diabetic foot successfully treated !!
Overview of Diabetic Foot Infections
7% of Population
Diabetic
15-25% Develop Foot Ulcer
40-80% Infected
(or suspected)
40% Mild
30-40% Moderate
Slide courtesy of Ben Lipsky, Puget Sound VA, Seattle
20-30% Severe
Healing
Infection
Replace
Lose
footwear
footwear
Offloading
Amputation
Wound
Based on the underlying mechanisms
Neuropathic
Painless/callus/ pulse+/pressure site/pink
Ischemic
Painful/Bulla/Pulseless/Tip of fingers/red
Infectious
below or between toes/purulent/deep ulcers
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Neuropathic ulcer
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Ischemic ulcer
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Small ulcer with big problem
Ischemic foot problem
Self amputation
Infectious ulcers
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Clinical Classification of Diabetic Foot Infection
Clinical Manifestations of Infection
Wound without purulence or other evidence of
inflammation
Uninfected
More than 2 of purulence, erythema, pain, tenderness,
warmth or induration. Any cellulitis/erythema extends
≤2 cm around ulcer and infection is limited to
skin/superficial subcut tissues. No local complications
or systemic illness
Mild
Infection in patient who is systemically well & metabolically
stable but has any of: cellulitis extending >2 cm;
Moderate
lymphangitis; spread beneath fascia; deep tissue
abscess; gangrene; muscle, tendon, joint or bone
involved
Infection in a patient with systemic toxicity or metabolic
instability
Severe
Epidemiology Pathophysiology Microbiology Assessment Biomechanics
1
2
3
4
IDSA Diabetic Foot Infection Classification
• Uninfected: lacking purulence or signs of inflammation
• Mild:infection limited to superficial tissue, cellulitis < 2 cm
around ulcer, no systemic signs
• Moderate: Systemically well & metabolically stable, > 1 ofcellulitis > 2 cm from ulcer, deep tissue involvement,
abscess, gangrene, involvement of muscle, tendon, joint or
bone
IDSA Classification
• Severe: foot infection and systemic toxicity and/or
metabolic instability
– Fever or chills
– Leukocytosis
– Tachycardia, hypotension
– Confusion
– Severe hyperglycemia or azotemia
WAGNER DIABETIC FOOT ULCER CLASSIFICATION SYSTEM
Grade
Description
0
No ulcer, but high-risk foot (e.g., deformity, callus, insensitivity)
1
Superficial full-thickness ulcer
2
Deeper ulcer, penetrating tendons, no bone involvement
3
Deeper ulcer with bone involvement, osteitis
4
Partial gangrene (e.g., toes, forefoot)
5
Gangrene of whole foot
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Classification
Type 2 or 3
Classification
Type 4
UNIVERSITY OF TEXAS WOUND CLASSIFICATION SYSTEM
Stage
Grade 0
A
Preulcer or postulcer Superficial ulcer Deep ulcer to
lesion
tendon or
No skin break
capsule
Wound
penetrating
bone or joint
B
+ Infection
+ Infection
+ Infection
+ Infection
C
+ Ischemia
+ Ischemia
+ Ischemia
+ Ischemia
D
+ Infection and
ischemia
+ Infection and
ischemia
+ Infection and
ischemia
+ Infection and
ischemia
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Grade 1
Grade 2
Grade 3