Published: 2020-01-27

A prospective study to determine the application of site, ischemia, neuropathy, bacterial infection and depth scoring in the outcome and management of diabetic foot ulcers

Ashwath V. H. Venkataramana, Manjunath B. D., Abdul Razack, Harindranath H. R., Hussain Arish


Background: The objective of the study was to classify diabetic ulcers based on the recently described SINBAD classification system and to determine the management based on SINBAD score.

Methods: Prospective study, conducted in Victoria Hospital from November 2017 to May 2019.  120 patients with diabetic ulcers were classified according to the SINBAD classification system, wherein a score of one is given for site beyond forefoot, presence of ischemia, presence of neuropathy, bacterial infection, area >1 cm2 and depth beyond subcutaneous tissue. The wounds are scored at presentation and the outcome are evaluated according to respective score.

Results: In this study 120 patients with mean age of 50.12 years were included. Lower socio-economic groups correlated with higher incidence of diabetic foot. According to SINBAD classification 42.5% had forefoot, 57.5% had hind foot wounds, 56.3% were purely ischemic ulcers, 19.2% were neuropathic ulcers, 40.0% were neuro-ischemic ulcers 68.3% had bacterial infection, 70.8% had ulcer, size >1 cm2, 55% had ulcer deeper than skin & sub cutaneous tissues. Healing probability in score 1 was 100%, score 2 was 87.5%, Score 3 was 70%, score 4 was 58.6% healing, score 5 was 7.1% and score 6 was 1.1% healing (p=0.004). Ischemia, neuropathy, bacterial infection, area >1 cm2 and depth beyond subcutaneous tissue had significant effect on healing.

Conclusions: SINBAD classification system includes 6 parameters, describing the pathological evolution of diabetic ulcers. Treatment protocols can be determined based on the score. The system is easy to score and apply in routine practise.



Classification, Diabetic foot, Diabetic foot scoring, Site, Ischemia, Neuropathy, Bacterial infection, Depth, Wound healing

Full Text:



Park K. Diabetes mellitus. Park textbook of preventive and social medicine. 24th edition. Banarasidas Bhanot Publishers; 2017: 410.

Boulton AJ. The diabetic foot: a global view. Diabetes/metabolism research and reviews. 2000;16(1):2-5.

Connor H. The high risk foot in diabetes mellitus. In: Robert G Frykberg. Churchill Livingstone, 1–3 Baxter's Place, Leith Place, Leith Walk: Edinburgh; 1991: 162.

Bajaj S, Mahajan A, Grover S, Mahajan V, Goyal P, Gupta VK. Peripheral vascular disease in patients with diabetic foot ulcers-an emerging trend: a prospective study from north India. J Assoc Physicians India. 2017;65(5):14-7.

Andrew JM, Boulton, VileiKyte L. Diabetic foot problems and their management around the world. Levin o neals. The Diabetic Foot. 6th edition. Mosby, Inc; 2001: 266.

Macfarlane RM, Jeffcoate WJ. Classification of diabetic foot ulcers: the S(AD)SAD system. Diabet Foot. 1999;2:123-31.

Ince P, Abbas ZG, Lutale JK, Basit A, Ali SM, Chohan F, et al. Use of the SINBAD classification system and score in comparing outcome of foot ulcer management on three continents. Diabetes Care. 2008;31(5):964-7.

Available at: footcare. Accessed May 30 2015.

Yazdanpanah L, Shahbazian H, Nazari I, Arti HR, Ahmadi F, Mohammadianinejad SE, et al. Incidence and Risk Factors of Diabetic Foot Ulcer: A Population-Based Diabetic Foot Cohort (ADFC Study)—Two-Year Follow-Up Study. Inter J Endocrinol. 2018;2018.

Khalifa WA. Risk factors for diabetic foot ulcer recurrence: a prospective 2-year follow-up study in Egypt. Foot. 2018;35:11-5.

Mark AK, Warren SJ. Update of treatment of diabetic foot infections. Clin Podiatr Med Surg. 2007;24:383-96.

Wagner Jr FW. The diabetic foot and amputation of the foot, in surgery of the foot. St. Louis, USA: Mosby; 1986: 421-455.

Abbas ZG, Archibald LK. Challenges for management of the diabetic foot in Africa: doing more with less. Inter Wound J. 2007;4(4):305-13.

Beckert S, Witte M, Wicke C, Königsrainer A, Coerper S. A new wound-based severity score for diabetic foot ulcers: a prospective analysis of 1,000 patients. Diabetes Care. 2006;29(5):988-92.