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Orthopaedics
Classification of Diabetic Foot Disease
Built from The Surgical Management of the Diabetic Foot and Ankle
What’s inside
9 sections · 127 slides
Overview
- Purpose of a disease classification
- Scope of this topic
Charcot Arthropathy: Background
- Historical origins of Charcot arthropathy
- Definition and distribution of diabetic Charcot arthropathy
- Factors determining treatment of Charcot arthropathy
- Two families of Charcot classification systems
Eichenholtz Temporal Staging
- Origin of the Eichenholtz classification
- Rationale for adding stage 0
- Eichenholtz stage 0: the foot at risk
- Eichenholtz stage I: stage of development and fragmentation
- Eichenholtz stage II: stage of coalescence
- Eichenholtz stage III: stage of reconstruction and reconstitution
- Progression through the Eichenholtz stages
- Midfoot radiographs through the Eichenholtz stages
- Reading the midfoot radiographs
- Eichenholtz stages: clinical, radiographic and MRI findings
- Eichenholtz stages: clinical, radiographic and MRI findings (continued)
- Eichenholtz stages: treatment by stage
- Eichenholtz stages: treatment by stage (continued)
- Limitations of the Eichenholtz classification
- Clinical value of the Eichenholtz classification
Anatomic Systems: Harris-Brand, Cofield, Sammarco
- Contribution of Harris and Brand
- The three-pillar concept of Harris and Brand
- Three weight-bearing pillars of the neuropathic foot
- Posterior and central pillar patterns
- Anterior pillar, medial arch pattern
- Anterior pillar, lateral arch pattern
- Cuneiform-metatarsal base pattern and legacy of the system
- Anatomic classification of Cofield
- The three Cofield patterns
- Chronic Charcot arthropathy of the second metatarsophalangeal joint
- Anatomic classification of Sammarco and Conti
- Sammarco and Conti patterns 1 and 2
- Sammarco and Conti patterns 3, 4 and 5
The Brodsky Anatomic Classification
- Origin and principle of the Brodsky classification
- Brodsky anatomic zones of the foot and ankle
- Reading the Brodsky zone diagram
- Brodsky type I: tarsometatarsal or naviculocuneiform joints
- Midfoot ulceration and its reconstruction in Brodsky type I
- Brodsky type II: subtalar and Chopart joints
- Hindfoot collapse in Brodsky type II Charcot arthropathy
- Brodsky type 3A: the ankle joint
- Ankle valgus and malleolar ulceration in Brodsky type 3A
- Brodsky type 3B: fracture of the calcaneal tuberosity
- Calcaneal tuberosity avulsion with overlying soft-tissue compromise
- Brodsky types 4 and 5
- Brodsky types ordered from distal to proximal
The Schon Midtarsus Classification
- Origin of the Schon classification
- Lateral column collapse and the Schon measurements
- Schon patterns of acquired midtarsus deformity
- Radiographic angles used to quantify midtarsal deformity
- Angles used to quantify midtarsal deformity
- Clinical severity stages of arch collapse
- Schon clinical deformity severity stages
- The Schon radiographic severity scale
- Criteria defining a beta stage deformity
- Schon type I: metatarsocuneiform, metatarsocuboid or Lis-Franc pattern
- Severe midfoot abduction in Schon type I deformity
- Schon type II: naviculocuneiform, metatarsocuboid pattern
- Rocker-bottom deformity in Schon type II
- Schon type III: perinavicular pattern
- Lateral column depression in Schon type III
- Schon type IV: transverse tarsal pattern
- Extreme calcaneal pitch reversal in Schon type IV
- Frequency of the four Schon types
- Schon type I - Metatarsocuneiform/metatarsocuboid or Lis-Franc pattern
- Schon type II - Naviculocuneiform/metatarsocuboid pattern
- Schon type III - Perinavicular pattern
- Schon type IV - Transverse tarsal pattern
Choosing Between the Charcot Systems
- Value of the temporal classification
- Comparing the Schon and Brodsky systems
- Recommended approach to classifying the Charcot foot
Classification of Diabetic Foot Ulcers
- Parameters that could classify a diabetic foot lesion
- Design principle of ulcer classification systems
- The four commonly cited ulcer classification systems
- Origin and structure of the Wagner-Meggitt classification
- Wagner-Meggitt grades in sequence
- Wagner-Meggitt grades of diabetic foot lesions
- Clinical appearance of each Wagner-Meggitt grade
- Reading the Wagner-Meggitt photographs
- Strengths of the Wagner-Meggitt classification
- The progression misconception in Wagner-Meggitt
- The case for grading infection and ischemia separately
- Ischemia coexisting with ulceration
- The depth-ischemia classification of Brodsky
- Depth and ischemia read as two independent axes
- Depth-ischemia classification: depth grades and ischemia grades
- Depth-ischemia classification: depth grades and ischemia grades (continued)
- Limitations of the depth-ischemia classification
- The University of Texas classification
- University of Texas classification: depth grades with infection and ischemia stages
- Origin and purpose of the IWGDF classification
- The PEDIS parameters
- Distinctive features of the IWGDF system
- Predictive value of the IWGDF infection grade
- IWGDF PEDIS criteria for perfusion, extent, depth, infection and sensation
- IWGDF PEDIS criteria for perfusion, extent, depth, infection and sensation (continued)
- IWGDF PEDIS criteria for perfusion, extent, depth, infection and sensation (continued)
- IWGDF PEDIS criteria for perfusion, extent, depth, infection and sensation (continued)
- IWGDF PEDIS criteria for perfusion, extent, depth, infection and sensation (continued)
- IWGDF PEDIS criteria for perfusion, extent, depth, infection and sensation (continued)
- IWGDF PEDIS criteria for perfusion, extent, depth, infection and sensation (continued)
- IWGDF PEDIS criteria for perfusion, extent, depth, infection and sensation (continued)
- IWGDF PEDIS criteria for perfusion, extent, depth, infection and sensation (continued)
- IWGDF PEDIS criteria for perfusion, extent, depth, infection and sensation (continued)
- IWGDF PEDIS criteria for perfusion, extent, depth, infection and sensation (continued)
- IWGDF PEDIS criteria for perfusion, extent, depth, infection and sensation (continued)
- IWGDF PEDIS criteria for perfusion, extent, depth, infection and sensation (continued)
Choosing Between the Ulcer Systems
- Summary comparison of the ulcer classification systems
- Practical recommendation on ulcer classification
- Key points on classification of diabetic foot disease
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- The Surgical Management of the Diabetic Foot and Ankle