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A simple scoring system may help clinicians predict which diabetic foot ulcers are unlikely to heal with standard therapy, according to a new study. Typically larger and deeper than average, most of these hard-to-treat ulcers have existed longer than ulcers that respond to standard therapies.


Researchers developed an ulcer scoring system by studying the outcomes of more than 27,000 people with diabetic foot ulcers, 47% of which had healed by week 20 of care. All patients had adequate blood flow but poor nerve sensitivity in their feet. Treatment included standard wound care, removal of dead tissue as needed, and use of pressure-reducing methods.


Researchers found that ulcer duration, depth, and size were the most important variables influencing the success of ulcer treatment. They assigned each variable a score of zero or one, so possible total scores ranged from zero (the best rating) to three (the worst rating).


A score of zero was associated with a 33% likelihood that the wound wouldn't heal after 20 weeks of care. With a score of three, the likelihood that the wound wouldn't heal rose to 79%. Researchers say this simple assessment tool can help clinicians identify stubborn ulcers that are unlikely to respond to standard care and revise the treatment plan accordingly.




"Diabetic Neuropathic Foot Ulcers: Predicting Which Ones Will Not Heal," American Journal of Medicine, D. Margolis, et al., December 1, 2003.