Wagner Classification of Diabetic Foot Ulcers

Grade 0: No ulcer in a high risk foot.

Grade 1: Superficial ulcer involving the full skin thickness but not underlying tissues.

Grade 2: Deep ulcer, penetrating down to ligaments and muscle, but no bone involvement or abscess formation.

Grade 3: Deep ulcer with cellulitis or abscess formation, often with osteomyelitis.

Grade 4: Localized gangrene.

Grade 5: Extensive gangrene involving the whole foot.

University of Texas Wound Classification System of Diabetic Foot Ulcers

Grade I-A: non-infected, non-ischemic superficial ulceration

Grade I-B: infected, non-ischemic superficial ulceration

Grade I-C: ischemic, non-infected superficial ulceration

Grade I-D: ischemic and infected superficial ulceration

Grade II-A: non-infected, non-ischemic ulcer that penetrates to capsule or bone

Grade II-B: infected, non-ischemic ulcer that penetrates to capsule or bone

Grade II-C: ischemic, non-infected ulcer that penetrates to capsule or bone

Grade II-D: ischemic and infected ulcer that penetrates to capsule or bone

Grade III-A: non-infected, non-ischemic ulcer that penetrates to bone or a deep abscess

Grade III-B: infected, non-ischemic ulcer that penetrates to bone or a deep abscess

Grade III-C: ischemic, non-infected ulcer that penetrates to bone or a deep abscess

Grade III-D: ischemic and infected ulcer that penetrates to bone or a deep abscess

References:

1. Armstrong DG, Lavery LA, Harkless LB. Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation. Diabetes Care. 1998 May;21(5):855-9. [Medline]

2. Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJ. A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound classification systems. Diabetes Care. 2001 Jan;24(1):84-8. [Medline]

3. Wagner FW: Supplement: algorithms of foot care. In The Diabetic Foot. 3 rd ed. Levin ME, O’Neal LW, Eds. St. Louis, MO, CV. Mosby, 1983, p. 291–302

4. Lavery LA, Armstrong DG, Vela SA, Quebedeaux TL, Fleischli JG. Practical criteria for screening patients at high risk for diabetic foot ulceration. Arch Intern Med. 1998 Jan 26;158(2):157-62. [Medline]

Created: April 13, 2006