We were very encouraged by the helpful and supportive comments of Drs Apelqvist, Bakker, Serra and Young (The Diabetic Foot 3(1): 10-11). Ms Foster and Dr Edmonds (above) are more critical but their points can be easily resolved by reasoned debate. We are enthusiastic about the suggestion that an international meeting should be held in order to achieve consensus because we feel that the establishment of a robust classification is essential if we are to undertake the scientific research necessary to define optimum patterns of management.
We agree with Dr Robert Young that the system we have proposed still contains unintended imprecision and that this needs to be eliminated. We also agree that validation is required, and have started to do this ourselves. So far this year we have classified 80 new lesions – with the eventual aim of correlating the coding with outcome. We have found it to be simple to apply and unambiguous, and look forward to more details of Professor Serra’s experience in Oporto. We recognise, however, that for the purposes of validation, coding should be properly undertaken by someone uninvolved in clinical management, and there also needs to be some assessment of inter-rater reliability.
We are very keen to involve other units in this process and would like to take this opportunity to ask for anybody who is potentially interested in participating to contact us.
