UT Diabetic Foot Classification System


The University of Texas Diabetic Foot Classification System

Category 0

 No
Pathology

Category 1a

Neuropathy,
No Deformity

Category 2a

Neuropathy
with Deformity

Category 3a

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