TEXAS grading and staging of diabetic foot In order to better assess the staging of diabetic foot and determine the prognosis, some new diagnostic and classification criteria have emerged. The more commonly used one is the TEXAS University diabetic foot grading (staging) method. This method is a classification that assesses the degree of foot and lower extremity ulceration. Standardized assessment criteria are developed based on the depth of the lesion, sensory neuropathy, inadequate blood supply and infection. Grading Clinical presentation Staging Clinical presentation 1. History of foot ulcer A without infection and ischemia 2. Superficial ulcer B with infection 3. Ulcer deep to the tendon C with ischemia 4. Ulcer involving the joint D with infection and ischemia For example, grade 1 stage A indicates a history of foot ulcer without infection and ischemia; grade 3 stage C indicates an ulcer deep to the tendon in the foot with foot ischemia, and so on. Data show that the amputation rate increases with the depth of the ulcer and the severity of the stage, with none of the ulcers without infection and ischemia being amputated during the follow-up period, 11-fold higher for ulcers deep to bone tissue, and nearly 90-fold higher for those with coexisting infection and ischemia. One study found that when the factors of neuropathy, deformity, and arterial occlusion were analyzed separately, patients with arterial occlusive disease had significantly more foot ulcers, infections, amputations, and hospitalizations, while those with neuropathy had no different outcomes than those with neuropathy with foot and ankle deformity. Therefore, instead of using deformity as a decisive risk factor for grouping, arterial occlusion, history of foot ulceration, and history of amputation were considered as the most important risk factors for separate risk stratification. Patients applying the TEXAS University diabetic foot classification of grades 2 to 4 account for 20% of diabetic foot patients, but 70% of ulcers, and 90% of amputations and hospitalizations. Understanding this 20/80 rule can help make diabetic foot professionals more helpful to those risk groups with the greatest developmental disease rates and costs; providing the most effective health care for the prevention of these populations can contribute to a reduction in costs to society. This is different from focusing on a single risk factor, such as neuropathy.