A prospective observational study of role of pedis scoring in predicting complications of diabetic foot in a tertiary centre


  • Sivaranjani Sivakumar Department of General Surgery, Apollo main hospital, Chennai, Tamil Nadu, India
  • Rajesh Kesavan Department of General Surgery, Apollo main hospital, Chennai, Tamil Nadu, India
  • Balachandar Kariappa Reddy Department of Podiatric Surgery, Apollo main hospital, Chennai, Tamil Nadu, India




Diabetic foot ulcer, PEDIS scoring, Osteomyelitis, Non healing, Amputation


Background: Diabetes mellitus is one of the most common non-communicable diseases affecting major population in the world. Diabetic foot ulcer still remains the most common manifestation of diabetes mellitus requiring hospitalisation and invariably resulting in increased risk of morbidity. Our aim is to know the usefulness of PEDIS scoring in identifying the severity of diabetic foot ulcer and its management.

Methods: In this prospective observational study, data of patients with foot ulcer who came to Apollo hospital in Chennai were collected for one year from July 2021 to May 2022. They were followed up for a period of six months. Patients were assessed and classified according to the PEDIS scoring system. All the data were analyzed by IBM SPSS statistics for windows version 25.0 (IBM corp, Armonk, Newyork USA). All p values <0.05 were considered as statistically significant.

Results: Out of one seventy-five patients, one hundred and thirteen were categorized as low risk group with a score between 0-7 and sixty-two as high-risk group with a score between 8-12. Majority of the high-risk groups developed complications like non healing ulcer, osteomyelitis, amputation. It is more prevalent among men with age preponderance for elderly. Whereas management of low-risk groups were limited only to conservative management and debridement. Of twenty-one patients with osteomyelitis, thirteen patients underwent amputation.

Conclusions: Based on our study, we have come to a conclusion that the PEDIS scoring system actually helps in grading the diabetic foot and its management.


Kharroubi AT, Darwish HM. Diabetes mellitus: The epidemic of the century. World J Diab. 2015; 6(6):850.

Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005; 293(2):217-28.

Ousey K, Chadwick P, Jawień A, Tariq G, Nair HK, Lázaro-Martínez JL, et al. Identifying and treating foot ulcers in patients with diabetes: saving feet, legs and lives. J Wound Care. 2018; 27(5):S1-52.

Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366(9498):1719-24.

Gandhi C, Kadam P, Kamepalli V, Kadam Y. PEDIS grading and its role in diabetic foot ulcer management. Int Surg J. 2019;6(7):2548-52..

Hüsers J, Hafer G, Heggemann J, Wiemeyer S, John SM, Hübner U. Predicting the amputation risk for patients with diabetic foot ulceration-a Bayesian decision support tool. BMC Med Inform Desicion Making. 2020;20(1):1-0.

Vukojević Z, Pekmezović T, Nikolić A, Perić S, Basta I, Marjanović I, Lavrnić D. Correlation of clinical and neurophysiological findings with health-related quality of life in patients with diabetic polyneuropathy. Vojnosanitetski Pregled. 2014;71(9):23-9.

Akbari CM, Macsata R, Smith BM, Sidawy AN. Overview of the diabetic foot. Vasc Surg. 2003; 16(1):3-11.

Thiruvoipati T, Kielhorn CE, Armstrong EJ. Peripheral artery disease in patients with diabetes: Epidemiology, mechanisms, and outcomes. World J Diab. 2015;6(7):961.

Kim PJ, Steinberg JS. Complications of the diabetic foot. Endocrinol Metab Clin. 2013;42(4): 833-47.

Agale SV. Chronic leg ulcers: epidemiology, aetiopathogenesis, and management. Ulcers. 2013.

Saltzman CL, Hagy ML, Zimmerman B, Estin M, Cooper R. How effective is intensive nonoperative initial treatment of patients with diabetes and Charcot arthropathy of the feet?. Clin Orthopaed Related Res. 2005;435:185-90.

Giurato L, Meloni M, Izzo V, Uccioli L. Osteomyelitis in diabetic foot: a comprehensive overview. World J Diab. 2017;8(4):135.

Hartemann-Heurtier A, Senneville E. Diabetic foot osteomyelitis. Diab Metab. 2008;34(2):87-95.

Lipsky BA. Osteomyelitis of the foot in diabetic patients. Clin Infect Dis. 1997;25(6):1318-26.

Morales LR, González FML, Martinez HD, Beneit MJV, Guisado JS, Gonzalez JMA. Validating the probe-to-bone test and other tests for diagnosing chronic osteomyelitis in the diabetic foot. Diab Care. 2010;33(10):2140-5.

Akhi MT, Ghotaslou R, Memar MY, Asgharzadeh M, Varshochi M, Pirzadeh T, et al. Frequency of MRSA in diabetic foot infections. Int J Diab Develop Count. 2017;37(1):58-62.

Steed DL. Debridement. Am J Surg. 2004;187(5):S71-4.

Nather A, Chionh SB, Han AY, Chan PP, Nambiar A. Effectiveness of vacuum-assisted closure (VAC) therapy in the healing of chronic diabetic foot ulcers. Ann Acad Med Singapore. 2010;39(5):353.

Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJ. A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound classification systems. Diab Care. 2001;24(1):84-8.

Jeffcoate WJ, Chipchase SY, Ince P, Game FL. Assessing the outcome of the management of diabetic foot ulcers using ulcer-related and person-related measures. Diab Care. 2006;29(8):1784-7.

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. Diab Care. 2008;31(5):964-7.

Małecki R, Klimas K, Kujawa A. Different patterns of bacterial species and antibiotic susceptibility in diabetic foot syndrome with and without coexistent ischemia. J Diab Res. 2021.

Dinh T, Veves A. The influence of gender as a risk factor in diabetic foot ulceration. Wounds. 2008; 20(5):127-31.

Ahmad W, Khan IA, Ghaffar S, Al-Swailmi FK, Khan I. Risk factors for diabetic foot ulcer. J Ayub Med Coll Abbottabad. 2013;25(1-2):16-8.

Iraj B, Khorvash F, Ebneshahidi A, Askari G. Prevention of diabetic foot ulcer. Int J Prevent Med. 2013;4(3):373.

Lam K, Van Asten SA, Nguyen T, La Fontaine J, Lavery LA. Diagnostic accuracy of probe to bone to detect osteomyelitis in the diabetic foot: a systematic review. Clin Infect Dis. 2016;63(7): 944-8.

Mutluoglu M, Uzun G, Sildiroglu O, Turhan V, Mutlu H, Yildiz S. Performance of the probe-to-bone test in a population suspected of having osteomyelitis of the foot in diabetes. J Am Podiatr Med Assoc. 2012;102(5):369-73.

Chuan F, Tang K, Jiang P, Zhou B, He X. Reliability and validity of the perfusion, extent, depth, infection and sensation (PEDIS) classification system and score in patients with diabetic foot ulcer. PloS one. 2015;10(4): e0124739.

Al-Rubeaan K, Al Derwish M, Ouizi S, Youssef AM, Subhani SN, Ibrahim HM, Alamri BN. Diabetic foot complications and their risk factors from a large retrospective cohort study. PloS one. 2015;10(5):e0124446.

Armstrong DG, Boulton AJ, Bus SA. Diabetic foot ulcers and their recurrence. New Eng J Med. 2017;376(24):2367-75.






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