PedalScreen

Clinical Findings

Loss of Protective SensationMonofilament / tuning fork abnormal

Peripheral Arterial DiseaseAbsent pedal pulses / ABI < 0.9

Foot DeformityHallux valgus, claw/hammer toes, Charcot, etc.

History of Foot Ulcer

History of Lower-Extremity Amputation

End-Stage Renal DiseaseOn dialysis or eGFR < 15

Ulcer Characteristics

SiteLocation of the ulcer

How to assess

Score 0 — Forefoot: Ulcer is on the toes, metatarsal heads, or plantar forefoot.
Score 1 — Midfoot/Hindfoot: Ulcer is on the arch, heel, ankle, or dorsum of the foot proximal to the metatarsal heads. Midfoot and hindfoot ulcers are associated with poorer healing outcomes.

IschaemiaPedal pulse palpation

How to assess

Palpate the dorsalis pedis (DP) pulse on the dorsum of the foot and the posterior tibial (PT) pulse behind the medial malleolus.

Score 0: At least one pedal pulse is palpable.
Score 1: Both DP and PT pulses are non-palpable. If uncertain, an ankle-brachial index (ABI) < 0.9 supports the presence of peripheral arterial disease.

NeuropathyLoss of protective sensation present

How to assess

Test with a 10g Semmes-Weinstein monofilament at three or more plantar sites (first toe, first and fifth metatarsal heads). Apply the monofilament perpendicular to the skin until it buckles and hold for approximately 1 second. Ask the patient to say when they feel pressure.

Neuropathy present: Inability to detect the monofilament at one or more sites. A 128Hz tuning fork on the hallux can supplement the assessment.

Bacterial InfectionClinical signs of infection present

How to assess

Assess for two or more of the following cardinal signs: erythema (redness extending from the wound edge), warmth, tenderness or pain, swelling, and purulent discharge.

Consider the IWGDF/IDSA infection classification for severity grading. Note that neuropathic ulcers may lack pain even when infected, so rely on other signs.

AreaUlcer surface area

How to assess

Measure the greatest length of the wound and the greatest width perpendicular to that length (in cm). Multiply to estimate surface area.

Score 0: ≤ 1 cm²
Score 1: > 1 cm²

Use a disposable ruler or wound measurement guide. Tracing on a transparent grid can improve accuracy.

DepthWagner classification

How to assess

Gently probe the wound with a sterile instrument to determine the depth of tissue involvement.

Score 0 — Superficial (Wagner 1): Ulcer involves the epidermis and dermis only. No tendon, capsule, or bone is visible or palpable at the wound base.
Score 1 — Deep (Wagner ≥ 2): Ulcer penetrates beyond the dermis to tendon, joint capsule, or bone. A positive probe-to-bone test suggests osteomyelitis and scores as deep.

Outcome	Lower (0–2)	Higher (3–6)	Overall
12-wk Healing	66.2%	24.8%	51.5%
26-wk Healing	100%	57.0%	78.2%
Median Heal Time	6.0 wk	21.9 wk	11.0 wk
Amputation Rate	18.8%	21.4%	18.2%

About PedalScreen

PedalScreen integrates two established systems for diabetic foot evaluation:

IWGDF 2023 Risk Stratification — classifies patients without active ulceration into risk levels 0–3 based on the International Working Group on the Diabetic Foot guidelines, with corresponding screening intervals.
SINBAD Classification — scores active diabetic foot ulcers on six binary criteria (Site, Ischaemia, Neuropathy, Bacterial infection, Area, Depth) as described by Ince et al. (2008). Pilot study outcome data is displayed alongside the score to support evidence-informed clinical decisions.

A validation study examining SINBAD scoring and healing outcomes in delayed-healing DFUs is currently under review for publication.

No patient-identifiable information is collected, stored, or transmitted by this tool. Assessment data entered is used only for on-screen scoring and optional PDF report generation. Aggregate usage metrics are recorded to monitor tool adoption.

Intended Use: PedalScreen is a clinical decision-support tool intended for use by licensed healthcare providers with clinical competency in lower-extremity wound assessment. It is not intended for use by patients or the general public.

Not a Medical Device: PedalScreen has not been cleared or approved by the U.S. Food and Drug Administration (FDA) and is not classified as a medical device. It does not diagnose, treat, cure, or prevent any disease or condition. The tool provides informational and educational scoring based on published, peer-reviewed classification systems.

No Substitute for Clinical Judgement: All output from PedalScreen — including risk levels, SINBAD scores, and pilot study reference data — is intended to supplement, not replace, the independent clinical judgement of the treating provider. The clinician bears full responsibility for all diagnostic and treatment decisions.

Pilot Study Data: Outcome reference data displayed within the SINBAD assessment is drawn from a single-centre retrospective pilot study (n = 33 ulcers) of delayed-healing diabetic foot ulcers. These figures may not be generalisable to other patient populations. The manuscript is currently under review.

Privacy: PedalScreen does not collect, store, or transmit any patient-identifiable information. When provided, NPI numbers are validated locally using the CMS Luhn check-digit algorithm and are not transmitted externally. Aggregate, non-identifiable usage metrics are recorded solely to monitor tool adoption.

Limitation of Liability: PedalScreen is provided "as is" without warranties of any kind. The developer assumes no liability for clinical outcomes resulting from the use of this tool.