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Wound mapping of diabetic foot ulcers, utilizing Snomed CT anatomy labelling, is it detailed enough for a specialist diabetes foot clinic?

A 2018/2019 Summer Studentship research project

This project is investigating whether the recommended MoH anatomy labelling system is sufficient to clearly label anatomical sites in DFUs and thus encouraging a structured standardised one. As a result of density mapping there will be a greater awareness of the most likely “problem” ulcer sites which may therefore assist in future prevention and intervention for these high risk patients.

Student: Tori Murray
Supervisors: Karyn Ballance (Diabetes Specialist Podiatrist)
Sponsor: TBC

Project brief


The Podiatrists at Diabetes Centre Foot Ulcer Clinic use an imaging device, Silhouette Star (ARANZ Medical Ltd, NZ) to capture wounds in almost 100% of their patients who attend with wounds. When an image is taken, the podiatrist uses the preprogrammed anatomical sites on Silhouette plus additional free text when more detailed labelling is required. There are variations in names of anatomical sites of the foot used by the diabetes podiatrists, they would like a more standardised labelling system. Snomed CT is an internationally recognised and Ministry of Health recommended labelling system. The objective of this observational study is to investigate if Snomed CT labelling is granular enough for use in a podiatry high risk foot setting.


To observe anatomical sites of Diabetic Foot Ulcers (DFUs) in patients who attended the Diabetes Centre Podiatry Clinics over a two and a half year period and compare the sites with internationally utilized and Ministry of Health (MoH) recommended anatomy labelling system Snomed CT.


The cohort are patients who attended the Diabetes Foot Ulcer Clinic or the Combined Vascular/Diabetes/ Infectious Diseases/ Foot Clinic at the Diabetes Centre at Christchurch Hospital. Patients who attended between January 1st 2016 until July 31st 2018 who had wounds and images taken using Silhouette Star will be included.

The investigator will map each wound site per patient onto an electronic image of a foot. The index wound will be identified. Any additional ulcers obtained in the observation period will be marked as secondary ulcers and also mapped. Each patient’s mapped foot will be layered on top of each other so that a density map will be created, an example of such mapping is one often used in population maps, or this following example:

With the assistance of Medical Illustrations, the areas of high to low density of ulceration will be mapped. The investigator will label these anatomical sites in accordance with Snomed CT. The hypothesis is that the anatomy labelling of the foot for DFUs needs to be more detailed than Snomed CT.

Data will be collated from Silhouette Central, (the data base where images are stored on Silhouette) and transferred to an Excel Spreadsheet in preparation for analysis which will be held within a password protected location, held behind the CDHB’s firewall. An HDEC (Ethics) Scope of Review form will be completed prior to undertaking the proposed study.

Student researcher’s component of the study

The student researcher will be the investigator to carry out the project, and present at the annual national diabetes conference (NZSSD). The Principle Supervisor will assist with meetings and mentorship.