Your Diabetic Foot Treatment Team: Why they must evaluate the depth and character of the wound.

In these discussions, we discuss each of the 7 essential skills that your diabetic foot treatment should possess. As an educated patient you will be able to evaluate the competency of your treatment team. Having a competent team will help you prevent an amputation related to your diabetes.

Today we will discuss essential skill number four
4. Evaluate the depth and character of the wound. (Perform a wound assessment that includes both staging/grading of infection and ischemia.)
Open sores on the feet of diabetic patients are very common. These of course are referred to as diabetic foot ulcerations. Not every diabetic foot ulcer will lead to an amputation. Having said that, most diabetic foot or amputations start as a diabetic foot ulcer.

Because of this, it is extremely important for you ta make sure your diabetic foot treatment team thoroughly evaluates any diabetic wound.

Anytime you have a serious medical condition, the first question is…how bad is it? For example if you have cancer, you want to know what stage of the cancer. The stage of the cancer will tell you the extent of the spread and likelihood that you will live or die.

In the same way, staging a diabetic foot ulcer can determine whether or not your foot will live or die. Determining the wound stage will help to determine whether or not you will need to be hospitalized, have intravenous antibiotics, surgery, or even an amputation.

Before describing the staging process, let me caution you as a patient. It is my long-held belief that medical school is a way for doctors to teach student doctors how to lose their ability to communicate with patients.

Classification systems are a very good example of this. In my residency (that had a heavy focus on diabetic foot training), my director understood this more than most. In our surgical conferences if a student or resident doctor mentioned a classification of any condition, Dr. Young would always demand that they explain exactly what that classification meant. This is a vital skill for clear communication. It shows that the doctor can know and explain what is really going on.

Many doctors lose disability. They become so familiar with the technical language and classification schemes, that they are simply unable to describe in simple terms what they see when they evaluate a wound, an illness or a condition.

So without giving you all the specifics about each of the different classification schemes, we will explain what the components are that need to be evaluated and why each is important.

The first component of a diabetic foot ulcer (open wound) classification system that should be evaluated by your treatment team is the size of the hole. It doesn’t really matter how big it is across your foot, but it doesn’t matter how deep. The skin on the foot is very thin and when a diabetic ulcer gets deeper, tendons, ligaments, and bone can become exposed and damaged or infected. Bones and joints that is clearly exposed to the external world through an open diabetic wound can only very rarely be saved.

Not surprisingly, as the wound becomes deeper. The condition is taken much more seriously. In general, skin will not just grow in and cover exposed tendons and ligaments, joints or bones. Action must be taken. In many cases this means surgery. A hope and a prayer is rarely enough.

Once your team has decided how deep it (and what tissues are exposed through the wound) they should next determined whether or not infection is present. This is usually not difficult. Any experience treatment team should be able to determine easily if the wind is infected or not. By definition, if your team cultures the wound, they believe that it is infected. See essential number three.

Next they should determine whether or not there is sufficient blood flow to heal the wound. Poor blood flow to an area is referred to by doctors as “ischemia.” You have to remember that any antibiotics are delivered to the foot through the bloodstream. If the blood flow is poor, the antibiotics can’t even get to the site where the battle is taking place. In addition, there is very little chance of the wound healing without good blood flow.

If the ischemia (or poor circulation) gets bad enough, gangrene can set in. Gangrene is nothing more than death of the tissue. It is often related to infection. Obviously is critical to your team and evaluates the blood flow to your feet whenever you have a diabetic foot wound.

If you have ischemia and an open sore on a single toe, and your treatment seem decides to amputate that toe, it is possible that the blood flow is so bad that the amputation site won't heal. This could create an even larger problem hole in your foot. It is a very basic tenant of diabetic foot surgery that the level of amputation must have sufficient blood flow to heal. Otherwise you may end up with each of your little piggy’s going to market one at a time.

By evaluating the depth of the wound ( including skin, tendon, joint, and bone involvement), presence or absence of infection, and presence or absence of ischemia, a much more realistic prognosis can be determined. All of these factors must be considered in order to determine whether or not the wound is likely to heal without hospitalization and/or surgery.


If you have a diabetic foot ulceration that is being treated without evaluating all of these factors, it might serve you well to seek a second opinion. You should also feel you have the liberty to ask your doctor whether or not you have an infection, any ischemia, or exposed tendon or bone. This is your right. Expect your doctor to explain what is going on.

Beware of doctors who feel you don’t deserve answers.

Diabetes is a complicated disease. Diabetic foot problem likewise can be simple or complicated. In either case, an evaluation is warranted given the potential for the loss of a limb. This should never be taken lightly. Keep in mind that most diabetic foot ulcerations do not need to end up as an amputation.

Although all of this talk about amputations can certainly be frightening, you should remember that your diabetic treatment team is on your side. As long as they are vigilant, you should be able to avoid any of these complications. Make sure you get an evaluation early whenever you notice an open sore. And if necessary, evaluate your team based on these criteria.

Amputations are preventable. Live long and enjoy life!


Dr. Christopher Segler is an award winning diabetic foot specialist. Although he has performed diabetic foot amputations, he still believes that diabetic foot amputations result from the dismal performance of a failing health care system that prevents adequate patient education. It is his passion to teach strategies that can stop diabetic amputations. You can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.