"The Hidden Worries Below": Analyzing Diabetic Foot Ulcers and Their Grading

Detailed explanation of what diabetic foot ulcers
(Basic Introduction and Wound Grading for Diabetic Foot Ulcers)

Diabetes is a chronic metabolic disease that affects over 500 million people worldwide, who also suffer from its complications such as vascular and neuropathic disorders1. Among these, Diabetic Foot Ulcer (DFU) is one of the most common lower limb complications, with up to 19%-34% (approximately one quarter) of diabetic patients likely to experience “Diabetic Foot Ulcers” at some point in their lives2. This article will delve into the basic knowledge and introduction of diabetic foot ulcers, as well as the mainstream wound classification systems.

Basic Introduction: What is Diabetic Foot Ulcer (DFU)?

Diabetic Foot Ulcer (DFU) can occur in diabetic patients who have long been in a state of hyperglycemia, which damages peripheral nerves and blood vessels. If uneven pressure on the feet leads to calluses or trauma, it may further result in wounds that are difficult to heal and damage to the skin and mucosal tissues known as Diabetic Foot Ulcers (DFU)2. Moreover, the ulcers may not only be confined to the skin but can also affect deeper tissues such as ligaments, tendons, and bones3.

What we commonly refer to as "diabetic foot" should correctly be named "diabetes-related foot disease," which encompasses one or more of the following symptoms: peripheral neuropathy, peripheral artery disease, infection, diabetic foot ulcers (DFU), osteoarthropathy, gangrene, or amputation3.

Wound Grading System: Wagner Classification System

The Wagner Ulcer Classification System is currently the most common method for classifying diabetic foot ulcers4. It is based on the depth of wound penetration and the extent of tissue necrosis, divided into 6 grades (grades 0-5) 5. The purpose of wound grading is to help medical personnel quickly understand the extent of tissue damage in the patient's foot and to provide an appropriate treatment strategy.

Foot wounds should not be taken lightly by diabetic patients! Want to learn more about Diabetic Foot Ulcers (DFUs):

"The Global State and Recurrence of Diabetic Foot Ulcers"

"Self-Check: A Home Examination Guide for Symptoms of Diabetic Foot"

Reference：
• IDF Diabetes Atlas: https://diabetesatlas.org/. Accessed in Nov 2023
• Armstrong DG et al. N Engl J Med. 2017;376(24):2367-2375.
• van Netten JJ, Bus SA, Apelqvist J, et al. Diabetes Metab Res Rev. Published online May 15, 2023.
• Monteiro-Soares M et al. Diabetes Metab Res Rev. 2023;e3648.
• Wang X et al. World J Diabetes. 2022;13(12):1049-1065.