Unifying Concepts

Saint Elian Wound Score System for Diabetic Foot Ulcers

Foot ulcerations are among the most complex and heterogeneous complications in patients with diabetes. Skin ulcers need to be managed in different ways dependent on their etiology and pathogenesis.

The 10 Saint Elian Wound Score System (SEWSS) categories is helpful in guiding treatment decisions based on severity subcategories.

SEWSS Checklist of 10 Wound Severity Factors for Score and Grading

Anatomical Aggravating Factors Affected Tissues
Location (1-3)
1. Phalanges/digits
2. Metatarsal
3. Tarsal
Ischemia (0-3)
0. No
1. Mild
2. Moderate
3. Severe
1. Superficial (skin only)
2. Deep ulcer (below dermis)
3. All layers (bone and joint)
Topographic aspects (1-3)
1. Dorsal or plantar
2. Lateral or medial
3. Two or more
Infection (0-3)
0. No
1. Mild. Erythema <2 cm, induration, tenderness, warmth, and purulent discharge
2. Moderate. Erythema >2 cm, muscle, tendon, or bone or joint infection
3. Severe. systemic inflammatory response
Area (1-3)
1. Small <10 cm2
2. Medium 10-40 cm2
3. Big >40 cm2
Affected zones (1-3)
1. One
2. Two
3. Entire foot (multiple wounds)
Edema (0-3)
0. No
1. Periwound
2. Affected leg only
3. Bilateral secondary to systemic disease
Wound healing phase (1-3)
1. Epithelialization
2. Granulating
3. Inflammatory
Neuropathy (0-3)
0. No
1. Protective sensation or vibration diminished
2. Loss of protective sensation or vibration
3. Diabetic neuro-osteo artropathy-Charcot


Score Sum Grade  Prognosis
≤10 I, mild Likely successful wound healing
11-20 II, moderate Partial foot-threatening; outcome related to “state-of-the-art” therapies used and associated with a good patient biological response
21-30 III, severe Limb- and life-threatening; outcome unrelated to “state-of-the-art” therapies because of poor biological patient





  1. Martínez-De Jesús FR. A checklist system to score healing progress of diabetic foot ulcers. Int J Low Extrem Wounds. 2010;9(2):74‐83. [Medline]
  2. Huang Y, Xie T, Cao Y, et al. Comparison of two classification systems in predicting the outcome of diabetic foot ulcers: the Wagner grade and the Saint Elian Wound score systems. Wound Repair Regen. 2015;23(3):379‐385. [Medline]


Created May 29, 2020.

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