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Don’t Let Diabetes Pull Down Our Foot 421

3 CLI 1-3cm 2 Fascia, Ab- 2
Mus- scess,
cle, Fascitis,
tendon Arthritis
4 >3cm 2 Bone SIRS 3
or joint
Table 4.PEDIS classification

FACTORS CONTRIBUTING FOOT
ULCERATION
Multiple intrinsic and extrinsic factors contribute the
Table : 2-Wagner classification formation of diabetic foot ulcer as shown in Table 5.

University of Texas Diabetic Wound Intrinsic factors Extrinsic factors
Classification System • Bony prominences Walking barefoot
University of Texas classified foot ulcers based on • Limited joint mobility Inappropriate footwear
depth as grade and presence or absence of infection • Deformities Falls and accidents
/or ischemia as stages. The classification is shown
in Table 3 • Callus formation Objects inside shoes
• Previous foot ulcer Thermal trauma
Stage Grade • Neuroarthopathy (charcot) Activity level
0 I II III
Table: 5. Factors contributing diabetic foot ulcer
A Pre- or Superficial Wound Wound
(no Post- Ul- wound not penetrating penetrating
infection or cerative involving to tendon to bone or Various treatment modalities:
ischemia) lesion tendon, or capsule joint. 1. Wound debridement:
completely capsule, or
epithelial- bone. Never be kind with diabetic foot. All devitalized tis-
ized sues must be removed till fresh bleeding come. De-
bridement can be done by
B Infection Infection Infection Infection
C Ischemia Ischemia Ischemia Ischemia • Surgical (in fig 3 a.) • Larva (fig 3.b.)
D Infection Infection Infection Infection • Hydro surgery • Autolytic
and isch- and isch- and isch- and isch- • Ultrasonic
emia emia emia emia
Fig 3.a: Surgical debridement
Table 3. University of Texas classification Fig 3.b: Larva for wound debridement

PEDIS classification is based on the
expansion of each letter
• P-Perfusion • E-Extent • D-Depth
• I-Infection • S-Sensation

The system of PEDIS is shown in Table 4.
Grade Perfusion Extent Depth Infec- Sensa-
tion tion
1 No PAD Skin Skin None No 0
Intact Intact Loss
2 PAD NO <1cm 2 Super- Surface Loss 1
CLI ficial Fig 3.a: Surgical debridement

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