Performance of prognostic markers in the prediction of wound healing or amputation among patients with foot ulcers in diabetes: A systematic review

Rachael O. Forsythe*, Jan Apelqvist, Edward J. Boyko, Robert Fitridge, Joon Pio Hong, Konstantinos Katsanos, Joseph L. Mills, Sigrid Nikol, Jim Reekers, Maarit Venermo, R. Eugene Zierler, Nicolaas C. Schaper, Robert J. Hinchliffe

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

13 Citations (Web of Science)


Clinical outcomes of patients with diabetes, foot ulceration, and peripheral artery disease (PAD) are difficult to predict. The prediction of important clinical outcomes, such as wound healing and major amputation, would be a valuable tool to help guide management and target interventions for limb salvage. Despite the existence of a number of classification tools, no consensus exists as to the most useful bedside tests with which to predict outcome. We here present an updated systematic review from the International Working Group of the Diabetic Foot, comprising 15 studies published between 1980 and 2018 describing almost 6800 patients with diabetes and foot ulceration. Clinical examination findings as well as six non-invasive bedside tests were evaluated for their ability to predict wound healing and amputation. The most useful tests to inform on the probability of healing were skin perfusion pressure >= 40mmHg, toe pressure >= 30mmHg, or TcPO2 >= 25mmHg. With these thresholds, all of these tests increased the probability of healing by greater than 25% in at least one study. To predict major amputation, the most useful tests were ankle pressure

Original languageEnglish
Article number3278
Number of pages16
JournalDiabetes-metabolism Research and Reviews
Issue numberS1
Publication statusPublished - Mar 2020


  • amputation
  • diabetes
  • diabetic foot
  • ulcer
  • peripheral artery disease
  • prognosis

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