Management of diabetic foot ulcers and the challenging points: An endocrine view

Table 1 International Working Group on the Diabetic Foot risk classification system

Group	Definition	Ulcer risk	Screening
0	No LOPS and no PAD	Very low	Once a year
1	LOPS or PAD	Low	Once every 6-12 mo
2	LOPS + PAD or LOPS + FD or PAD + FD	Moderate	Once every 3-6 mo
3	LOPS or PAD with one or more of the following: (1) History of a foot ulcer; (2) A lower extremity amputation (major or minor); and (3) ESRD	High	Once every 1-3 mo

LOPS: Loss of protective sensation; PAD: Peripheral artery disease; FD: Foot deformity; ESRD: End-stage renal disease.

Table 2 Preventive measures for diabetic foot ulcers

	Preventive measures
1	Avoid smoking
2	Avoid walking barefoot/in socks without shoes/in thin-soled slippers
3	Avoid hot ground and hot sand
4	Inspect both feet and inside the shoes daily
5	Wash the feet daily (carefully dry especially between the toes)
6	Test water temperature before bath
7	Lubricate dry skin and avoid chemicals
8	Cut the toenails straight
9	Do not remove callus
10	Wear snug shoes (customize if feet have deformity)
11	Change the socks daily

Table 3 Classification systems of diabetic foot ulcers

Classifications system	The evaluated parameters
University of Texas System	Depth, infection, ischemia
Wagner	Depth, necrosis
PEDIS	Perfusion, extent, depth, infection, sensation
SINBAD	Site, ischemia, neuropathy bacterial infection, area, depth
Threatened limb classification: WIfI	Wound characteristics, ischemia, foot infection
IWGDF/IDSA system	Clinical manifestations, the severity of infection, PEDIS grade

IWGDF: International Working Group on the Diabetic Foot; IDSA: Infectious Disease Society of America.