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What is the official definition of a diabetic foot ulcer? Is any wound on the foot of a diabetic considered a diabetic foot ulcer. I have a patient with diabetes and paraplegia with a pressure ulcer on his heel. Is that also a diabetic ulcer?
Jul 29, 2021 by Jad Roeske, MD
3 replies
Samantha Kuplicki
Hi Jad! Thanks for your question. I'm sure my colleagues will chime in with a thoroughly cross referenced answer--but the cliff notes would be that:

No, the presence of DM does not make any ulceration on below the ankle a 'diabetic foot ulcer.' These ulcers are caused by repetitive injury, friction in one area due to bio mechanical deformities from sequelea of DM such as autonomic, motor and sensory neuropathy. These can be assessed by observing footwear and gait as precursors to injury in the area of ulceration. This is usually always from ambulatory, with few exceptions.

Pressure ulcers are from sustained, unrelieved pressure against a surface or medical device, which in the case of paraplegia, I would think this is a possible etiology.

I could go very in-depth on assessment parameters that are characteristic for each type, but I feel you're asking more regarding etiology factors.
Jul 29, 2021
Eugene Worth

Great question that frequently causes a coding and documentation conundrum. I would just add that many people document any ulcer below the ankle as a DFU in presence of diabetes. I see this as fraud and abuse.

Just my opinion, of course. As Samantha has said, etiology is the key to identifying these. I agree that the common etiology here is pressure, not repetitive stress injury.
Jul 29, 2021
Thank you both so much for your answer. That helps a lot.
Jul 30, 2021
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