Role of ulcer grading classification in predicting level of amputation in diabetic foot ulcer.


  • Khalil ur Rehman Fauji Foundation Hospital, Rawalpindi.
  • Muhammad Naeem Ashraf Wah Medical College, Wah Cantt.
  • Naveed Arshad Islamabad Medical and Dental College, Islamabad.
  • Saima Mir DHQ Teaching Hospital, Rawalpindi.
  • Nadeem Pasha Wah Medical College, Wah Cantt.



Amputation, Diabetic Foot, Ulcer


Objectives: The study was designed to analyze and predict the diabetic foot ulcer outcome in terms of either healing or progression to amputation in patients presenting with diabetic foot. Study Design: Cross Sectional study. Setting: POF Hospital Wah Cantt. Period: January 2017 to December 2017. Material & Methods: Demographics of patients along with duration of diabetic foot ulcer and its grade according to Wagner classification were recorded. Nonprobability consecutive sampling was done for the data collection. Management of ulcer was carried out with debridement, daily dressings and appropriate antibiotic. Patients were followed over period until ulcer healed completely or amputation performed. The outcome of diabetic foot ulcer was noted to complete the study. Results: One hundred patients with mean age were 54.24±3.65 years. Mean duration of diabetic ulcer was 17.61±4.6 days. All patients with grade I ulcer recovered completely without the need of amputation. Out of 25 patients with grade II ulcers 13 (52%) patients recovered without amputation while 12 (48%) patients had minor amputation. Similarly 16 patients presenting with grade III ulcers 12 (75%) had minor amputation while 4 (25%) underwent major amputation. Out of 18 patients with grade IV ulcers, 6 (33%) had minor amputation while 12 (67%) had major amputation. All 13 patients with grade V ulcer underwent major amputation. Relation of grades of ulcer with respect to level of amputation inside the grading classification of ulcer showed significant (p=0.000). Conclusion: Healing of the diabetic foot ulcer with preservation of limb function must be a goal of treating diabetic foot. Wagner classification of diabetic foot ulcer high grade is associated with increased risk along with high level of foot amputation.

Author Biographies

Khalil ur Rehman, Fauji Foundation Hospital, Rawalpindi.

FCPS (Surgery)

Associate Professor Surgery


Muhammad Naeem Ashraf, Wah Medical College, Wah Cantt.

FCPS (Surgery)

Professor Surgery


Naveed Arshad, Islamabad Medical and Dental College, Islamabad.


Assistant Professor Rehabilitation

Saima Mir, DHQ Teaching Hospital, Rawalpindi.

MD (Nephrology)

Senior Registrar

Nadeem Pasha, Wah Medical College, Wah Cantt.

FCPS (Plastic Surgery)

Assistant Professor