Skip to main content
Top

04-16-2016 | Diabetic foot | Book chapter | Article

4. Classification of Diabetic Foot Disease

Author: Ross Taylor, M.D., M.B.A.

Publisher: Springer International Publishing

Abstract

Diabetes affects almost 30 million Americans, of which 0.3 %, or almost 90,000 will sustain Charcot arthropathy yearly, and many more will experience ulceration. Both of these conditions are major precursors to one of the most dreaded complications of diabetes—amputation. This chapter examines the classification of these two separate but related conditions. Classification systems of Charcot arthropathy may be divided into two general categories, anatomic and temporal. Anatomic classification systems describe the location of the disease about the foot and ankle, while temporal staging systems describe the varied characteristics of this disease over time. Anatomic classification systems are important, as Charcot arthropathy behaves uniquely based on the location of disease about the foot and ankle. Appropriate treatment also depends on the stage of disease, which requires an accurate temporal staging system. Several classification systems are described, with each providing unique insights into this complex disease. In addition, four classification systems of diabetic foot ulcers will be reviewed as well.
Literature
1.
Charcot J. Sur quelaques arthropathies qui paraissent depender d'une lesion du cerveau ou de la moele epiniere. Arch Des Physiol Norm Path. 1868;1:161–71.
2.
Jordan W. Neuritic manifestations of diabetes mellitus. Arch Intern Med. 1936;57:145–87.
3.
Johnson JT. Neuropathic fractures and joint injuries. Pathogenesis and rationale of prevention and treatment. J Bone Joint Surg Am. 1967;49:1–30.PubMed
4.
Eichenholtz SN. Charcot joints. Springfield: C.C. Thomas; 1966.
5.
Classen JN, Rolley RT, Carneiro R, Martire JR. Management of foot conditions of the diabetic patient. Am Surg. 1976;42:81–8.PubMed
6.
Kiuru MJ, Pihlajamaki HK, Hietanen HJ, Ahovuo JA. MR imaging, bone scintigraphy, and radiography in bone stress injuries of the pelvis and the lower extremity. Acta Radiol. 2002;43:207–12.CrossRefPubMed
7.
Kiuru MJ, Pihlajamaki HK, Ahovuo JA. Bone stress injuries. Acta Radiol. 2004;45:317–26.CrossRefPubMed
8.
Dutta P, Bhansali A, Singh P, Mittal BR. Charcot’s foot: advanced manifestation of diabetic neuropathy. Postgrad Med J. 2004;80:434.CrossRefPubMedPubMedCentral
9.
Moore TE, Yuh WT, Kathol MH, el-Khoury GY, Corson JD. Abnormalities of the foot in patients with diabetes mellitus: findings on MR imaging. AJR Am J Roentgenol. 1991;157:813–6.CrossRefPubMed
10.
Chantelau E, Poll LW. Evaluation of the diabetic charcot foot by MR imaging or plain radiography—an observational study. Exp Clin Endocrinol Diabetes. 2006;114:428–31.CrossRefPubMed
11.
Shibata T, Tada K, Hashizume C. The results of arthrodesis of the ankle for leprotic neuroarthropathy. J Bone Joint Surg Am. 1990;72:749–56.PubMed
12.
Hastings MK, Johnson JE, Strube MJ, et al. Progression of foot deformity in Charcot neuropathic osteoarthropathy. J Bone Joint Surg Am. 2013;95:1206–13.CrossRefPubMedPubMedCentral
13.
Christensen TM, Gade-Rasmussen B, Pedersen LW, Hommel E, Holstein PE, Svendsen OL. Duration of off-loading and recurrence rate in Charcot osteo-arthropathy treated with less restrictive regimen with removable walker. J Diabetes Complications. 2012;26:430–4.CrossRefPubMed
14.
Fabrin J, Larsen K, Holstein PE. Long-term follow-up in diabetic Charcot feet with spontaneous onset. Diabetes Care. 2000;23:796–800.CrossRefPubMed
15.
Rudrappa S, Game F, Jeffcoate W. Recurrence of the acute Charcot foot in diabetes. Diabet Med. 2012;29:819–21.CrossRefPubMed
16.
Osterhoff G, Boni T, Berli M. Recurrence of acute Charcot neuropathic osteoarthropathy after conservative treatment. Foot Ankle Int. 2013;34:359–64.CrossRefPubMed
17.
Edmonds M, Watkins PJ. The Charcot joint: understanding its natural history leads to new treatment and prevention. Diabet Med. 1984;1.
18.
Pinzur MS, Lio T, Posner M. Treatment of Eichenholtz stage I Charcot foot arthropathy with a weightbearing total contact cast. Foot Ankle Int. 2006;27:324–9.PubMed
19.
Chantelau EA, Grutzner G. Is the Eichenholtz classification still valid for the diabetic Charcot foot? Swiss Med Wkly. 2014;144:w13948.PubMed
20.
Harris JR, Brand PW. Patterns of disintegration of the tarsus in the anaesthetic foot. J Bone Joint Surg. 1966;48:4–16.
21.
Cofield RH, Morrison MJ, Beabout JW. Diabetic neuroarthropathy in the foot: patient characteristics and patterns of radiographic change. Foot Ankle. 1983;4:15–22.CrossRefPubMed
22.
Sammarco GJ, Conti SF. Surgical treatment of neuroarthropathic foot deformity. Foot Ankle Int. 1998;19:102–9.CrossRefPubMed
23.
Brodsky JW. Personal communication. Accessed 15 Mar 2015.
24.
Johnson J, Klein SE, Brodsky JE. Diabetes. In: Coughlin M, Saltzman C, Anderson RB, editors. Mann’s surgery of the foot and ankle. 9th ed. Philadelphia: Elsevier; 2014. p. 1396–8.
25.
Brodsky J, Wagner F, Kwong P. Patterns of breakdown in the Charcot tarsus of diabetes and relation to treatment. Foot Ankle. 1986;5:353.
26.
Trepman E, Nihal A, Pinzur MS. Current topics review: Charcot neuroarthropathy of the foot and ankle. Foot Ankle Int. 2005;26:46–63.PubMed
27.
Biehl 3rd WC, Morgan JM, Wagner Jr FW, Gabriel R. Neuropathic calcaneal tuberosity avulsion fractures. Clin Orthop Relat Res. 1993;12:8–13.
28.
Hess M, Booth B, Laughlin RT. Calcaneal avulsion fractures: complications from delayed treatment. Am J Emerg Med. 2008;26:254.CrossRefPubMed
29.
Schon LC, Weinfeld SB, Horton GA, Resch S. Radiographic and clinical classification of acquired midtarsus deformities. Foot Ankle Int. 1998;19:394–404.CrossRefPubMed
30.
Schon LC, Easley ME, Cohen I, Lam PW, Badekas A, Anderson CD. The acquired midtarsus deformity classification system—interobserver reliability and intraobserver reproducibility. Foot Ankle Int. 2002;23:30–6.CrossRefPubMed
31.
Brodsky JW. Classification of foot lesions in diabetic patients. In: Pfeifer JHB, editor. Levin and O’Neal’s the diabetic foot. Philadelphia: Mosby Elsevier; 2008.
32.
Wagner FW. A classification and treatment program for diabetic, neuropathic and dysvascular foot problems, vol. 28. Rosemont: AAOS; 1979. p. 143–65.
33.
Wagner Jr FW. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle. 1981;2:64–122.CrossRefPubMed
34.
Calhoun JH, Cantrell J, Cobos J, et al. Treatment of diabetic foot infections: Wagner classification, therapy, and outcome. Foot Ankle. 1988;9:101–6.CrossRefPubMed
35.
Brodsky JW. Outpatient diagnosis and management of the diabetic foot AAOS. Instr Course Lect. 1993;42:121–39.PubMed
36.
Lavery LA, Armstrong DG, Harkless LB. Classification of diabetic foot wounds. J Foot Ankle Surg. 1996;35:528–31.CrossRefPubMed
37.
Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJ. A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound classification systems. Diabetes Care. 2001;24:84–8.CrossRefPubMed
38.
Schaper NC. Diabetic foot ulcer classification system for research purposes: a progress report on criteria for including patients in research studies. Diabetes Metab Res Rev. 2004;20 Suppl 1:S90–5.CrossRefPubMed
39.
Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karmicher AW, LeFrock JL, Lew DP, Mader JT, Norden C, Tan JS. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004;39:885–910.CrossRefPubMed
40.
Pickwell K, Siersma V, Kars M, et al. Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer. Diabetes Care. 2015;38(5):852–7.CrossRefPubMed

Be confident that your patient care is up to date

Medicine Matters is being incorporated into Springer Medicine, our new medical education platform. 

Alongside the news coverage and expert commentary you have come to expect from Medicine Matters diabetes, Springer Medicine's complimentary membership also provides access to articles from renowned journals and a broad range of Continuing Medical Education programs. Create your free account »