Classification of foot ulcers in people with diabetes: a systematic review.
Open accessAbstract
BACKGROUND: Classification and scoring systems can help both clinical management and audit the outcomes of routine care. AIM: This study aimed to assess published systems used to characterise ulcers in people with diabetes to determine which should be recommended to (a) aid communication between health professionals, (b) predict clinical outcome of individual ulcers, (c) characterise people with infection and/or peripheral arterial disease, and (d) audit to compare outcomes in different populations. This systematic review is part of the process of developing the 2023 guidelines to classify foot ulcers from the International Working Group on Diabetic Foot. METHODS: We searched PubMed, Scopus and Web of Science for articles published up to December 2021 which evaluated the association, accuracy or reliability of systems used to classify ulcers in people with diabetes. Published classifications had to have been validated in populations of >80% of people with diabetes and a foot ulcer. RESULTS: We found 28 systems addressed in 149 studies. Overall, the certainty of the evidence for each classification was low or very low, with 19 (68%) of the classifications being assessed by ≤ 3 studies. The most frequently validated system was the one from Meggitt-Wagner, but the articles validating this system focused mainly on the association between the different grades and amputation. Clinical outcomes were not standardized but included ulcer-free survival, ulcer healing, hospitalisation, limb amputation, mortality, and cost. CONCLUSION: Despite the limitations, this systematic review provided sufficient evidence to support recommendations on the use of six particular systems in specific clinical scenarios.
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In a prospective study of 1666 people with diabetes, equinus deformity was present in 10.3%.
“In a prospective study of 1666 people with diabetes, equinus deformity was present in 10.3% .31”
From Diabetic Foot Ulcers (2023) · cites this paper as [31]
The review’s Population section (2.2.1) defines eligible studies involving people with diabetes and foot ulcers, while its Eurodiale scores section (3.2.13) discusses amputation prediction, not equinus prevalence. Searches of our full-text copy for “equinus,” “1666,” and “10.3%” found no passage reporting the claimed prospective-study result. (LLM, conf=0.75)
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- Authors
- Monteiro‐Soares, M., Hamilton, E. J., Russell, D. A., Srisawasdi, G., Boyko, E. J., Mills, J. L., Jeffcoate, W., & Game, F.
- Affiliations
- Universidade do Porto (PT)
- The University of Western Australia (AU)
- University of Leeds (GB)
- Siriraj Hospital (TH)
- University of Washington (US)
- Baylor College of Medicine (US)
- Nottingham University Hospitals NHS Trust (GB)
- University Hospitals of Derby and Burton NHS Foundation Trust Derby UK
- ORCID
- Venue
- Diabetes/Metabolism Research and Reviews
- Publisher
- Wiley
- Published
- 2023-05-02
- Volume
- 40
- Issue
- 3
- Pages
- e3645-e3645
- ISSN
- 1520-7552 (ISSN-L)
- 1520-7560
- OpenAlex
- W4367834859
- Cited by
- 59
- References
- 139
- Citations by year
- 2026: 17 · 2025: 15 · 2024: 14 · 2023: 13
- FWCI
- 2.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes/Metabolism Research and Reviews (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NIHR300633)
- Raine Medical Research Foundation
- Fundação para a Ciência e a Tecnologia
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Dermatology › Skin Diseases and Diabetes
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Foot and Ankle Surgery
- Keywords
- diabetic foot ulcer, peripheral arterial disease, infection, amputation prediction, ulcer healing, clinical audit
- MeSH terms
- Diabetes Mellitus, Humans, Prognosis, Ulcer, Wound Healing, Reproducibility of Results, Foot Ulcer, Diabetic Foot
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