Abstract
Diabetes is a chronic disease that affects almost 19% of the elderly population in Brazil and similar percentages around the world. Amputation of lower limbs in diabetic patients who present foot complications is a common occurrence with a significant reduction of life quality, and heavy costs on the health system. Unfortunately, there is no easy protocol to define the conditions that should be considered to proceed to amputation. The main objective of the present study is to create a simple prognostic score to evaluate the diabetic foot, which is called Tardivo Algorithm. Calculation of the score is based on three main factors: Wagner classification, signs of peripheral arterial disease (PAD), which is evaluated by using Peripheral Arterial Disease Classification, and the location of ulcers. The final score is obtained by multiplying the value of the individual factors. Patients with good peripheral vascularization received a value of 1, while clinical signs of ischemia received a value of 2 (PAD 2). Ulcer location was defined as forefoot, midfoot and hind foot. The conservative treatment used in patients with scores below 12 was based on a recently developed Photodynamic Therapy (PDT) protocol. 85.5% of these patients presented a good outcome and avoided amputation. The results showed that scores 12 or higher represented a significantly higher probability of amputation (Odds ratio and logistic regression-IC 95%, 12.2–1886.5). The Tardivo algorithm is a simple prognostic score for the diabetic foot, easily accessible by physicians. It helps to determine the amputation risk and the best treatment, whether it is conservative or surgical management.
Highlights
Diabetes is a chronic disease, primarily related to insulin physiology but with consequences for the entire body
The patients were treated at the Center for Diabetic Foot at Hospital Anchieta (CeDiFo), served by the Faculdade de Medicina do ABC (FMABC), which is coordinated by Dr Tardivo
Diabetic patients referred for amputation were submitted to Photodynamic Therapy (PDT), and the following outcomes were observed: ulcer healing, osteomyelitis remission, referral to orthopedic foot specialist, referral for revascularization and surgery for amputation, as previously described [5,12]
Summary
Diabetes is a chronic disease, primarily related to insulin physiology but with consequences for the entire body. Around 10% of the American population suffer from diabetes and this percentage rises to 25% in the elderly [1]. In Brazil, 18.6% of the elderly population has been diagnosed as diabetic [2]. One of the major chronic complications of diabetes is associated with the foot, which can present various degrees of neurological and/or vascular disease and various degrees of ulceration, infection and PLOS ONE | DOI:10.1371/journal.pone.0135707. Diabetic foot is the most common cause of non-traumatic amputations of lower limbs [3]. 80% of lower limb amputations are performed in patients with peripheral vascular disease and/or diabetes [2]. Amputation of the lower extremities is one of the most feared complications for patients with diabetes mellitus, causing significant reduction in mobility and quality of life
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