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The basis of this classification, first described in 2003 and later validated in 2006, focuses on three fundamental variables which are present in the assessment of risk and indication: 1) the presence or absence of neuropathy (loss of protective sensation); 2) the presence or absence of an open wound; 3) the presence or absence of acute, limb-threatening infection. The conceptual framework for this classification is to define distinct classes of surgery in an order of theoretically increasing risk for high-level amputation. These classes include: Class I: Elective Diabetic Foot Surgery (procedures performed to treat a painful deformity in a patient without loss of protective sensation); Class II: Prophylactic (Procedure performed to reduce risk of ulceration or reulceration in person with loss of protective sensation but without open wound); Class III: Curative (Procedure performed to assist in healing open wound) and Class IV: Emergent (Procedure performed to limit progression of acute infection). The presence of critical ischaemia in any of these classes of surgery should prompt a vascular evaluation to consider a) the urgency of the procedure being considered and b) possible revascularization prior or temporally concomitant with the procedure. It is our hope that this system begins a dialogue amongst physicians and surgeons which can ultimately facilitate communication, enhance perspective, and improve care.

References:

Armstrong DG, Frykberg RF: Classifying diabetic foot surgery: toward a rational definition. Diabet Med. 2003 Apr;20(4):329-31

Armstrong DG, Lavery LA, Frykberg RG, Wu SC, Boulton AJ., Validation of a diabetic foot surgery classification., Int Wound J. 2006 Sep;3(3):240-6.

Diabetic Foot Surgery Class

Description

Very Low

Low

Moderate

Class III: Curative

Class IV: Emergency

Procedure performed to limit progression of acute infection.

Procedure performed to assist in healing open wound.

Class II: Prophylactic

Procedure performed to reduce risk of ulceration or reulceration in person with loss of protective sensation but without open wound.

Class I: Elective

Procedure performed to aleviate pain or limitation of motion in a person without loss of protective sensation.

High