UT Diabetic Foot Classification System

UT Diabetic Foot Classification System

The University of Texas Diabetic Foot Classification System

Category 0 No Pathology	Category 1 ^a Neuropathy, No Deformity	Category 2^a Neuropathy with Deformity	Category 3^a History of Pathology
Patient diagnosed with diabetes mellitus	Protective sensation absent by Semmes Weinstein test	Protective sensation absent	Protective sensation absent
Protective sensation intact by Semmes Weinstein test	ABI > 0.8 and toe systolic pressure > 45 mm Hg	ABI > 0.8 and toe systolic pressure > 45 mm Hg	ABI > 0.8 and toe systolic pressure > 45 mm Hg
Ankle-brachial index (ABI) > 0.08 and toe brachial index > 0.45 mm Hg	No history of ulceration	History of neuropathic ulceration	No history of neuropathic ulceration
Foot deformity may be present	No history of Charcot's joint	No history of Charcot's joint	History of Charcot's joint
No history of ulceration	No foot deformity	Foot deformity present	Foot deformity present
Possible Treatment Shoe accommodations Patient education Follow up 6 to 12 months	Possible Treatment Same as category 0 plus: Possible shoe gear accommodation Quarterly visits to assess shoe gear and monitor for signs of irritation Follow up 3 to 4 months	Possible Treatment Same as category 1 plus: Pedorthist/orthotist consultation for possible custom-molded/ extra-depth shoe accommodation Possible prophylactic surgery to alleviate foot deformity Follow up 2 to 3 months	Possible Treatment Same as category 2 plus: Pedorthist/orthotist consultation for possible custom-molded/ extra-depth shoe accommodation Possible prophylactic surgery to alleviate foot deformity More frequent visits may be indicated for monitoring Follow up 1 to 2 months
Category 4A Neuropathic Wound	Category 4B Acute Charcot's Foot	Category 5 The Infected Diabetic Foot	Category 6 The Ischemic Limb
Protective sensation absent	Protective sensation absent	Protective sensation may be present	Protective sensation may not be present
ABI > 0.8 and toe systolic pressure > 45 mm Hg	Hg ABI > 0.8 and toe systolic pressure > 45 mm Hg	Infected wound	ABI < 0.8 or toe systolic pressure < 45 mm Hg or pedal transcutaneous oxygen present tension < 40 mm Hgtension < 40 mm Hg
Foot deformity normally present	Non-infected neuropathic ulcer may be present	Charcot's joint may be present	Ulceration may be present
No Charcot's joint present	Charcot's joint present	Possible Treatment Debridement of infected, necrotic tissue and/or bone as indicated Possible hospitalization, institute antibiotic regimen Medical management	Possible Treatment Vascular consult, possible revascularization If infection present, treat as in Category 5. Vascular consultation with control of sepsis
Possible Treatment Same as category 3 plus: Pressure reduction program instituted Wound care program instituted	Possible Treatment Same as category 3 plus: Pressure reduction program instituted Thermometric and radiographic monitoring If ulcer present, same treatment as category 4A

a Categories 1-3 contain risk factors for ulceration; categories 4-6 contain risk factors for amputation