It is crucial to apply a standardized measurement system to evaluate whether a diabetic foot ulcer is responding to care, as a result several classification systems have been proposed.
At the present time no specific system has been universally accepted. Even so, most clinicians use one of the available systems when assessing and documenting a diabetic ulcer.
In this article we will discuss two commonly used classification systems; The Wagner diabetic foot ulcer grade classification system and the University of Texas diabetic foot ulcer classification system.
The Wagner Diabetic Foot Ulcer Grade Classification System
The Wagner diabetic foot ulcer classification system assesses ulcer depth and the presence of osteomyelitis or gangrene by using the following grades:
- Grade 0 – intact Skin
- Grade 1 – superficial ulcer of skin or subcutaneous tissue
- Grade 2 – ulcers extend into tendon, bone, or capsule
- Grade 3 – deep ulcer with osteomyelitis, or abscess
- Grade 4 – partial foot gangrene
- Grade 5 – whole foot gangrene
Note: While the wound shown in the above image may appear to be a grade 3 ulcer, upon assessment no abscess or osteomyelitis was found. Beneath the superficial necrotic tissue was exposed tendon.
The University of Texas Diabetic Foot Ulcer Classification System
The University of Texas system grades diabetic foot ulcers by depth and then stages them by the presence or absence of infection and ischemia:
- Grade 0 – pre-or postulcerative site that has healed
- Grade 1 – superficial wound not involving tendon, capsule, or bone
- Grade 2 – wound penetrating to tendon or capsule
- Grade 3 – wound penetrating bone or joint
Within each wound grade there are four stages:
- Stage A – clean wounds
- Stage B – non-ischemic infected wounds
- Stage C – ischemic noninfected wounds
- Stage D – ischemic infected wounds
Additional Diabetic Foot Ulcer Classification Systems
The following chart from Wounds International highlights additional classifications systems.
For detailed information on the above chart refer to “Best Practice Guidelines: Wound Management in Diabetic Foot ulcers”
While each system uses a different approach to classify a wound, similarly each system classifies the wound according to depth, presence of ischemia, and presence of infection.
Regardless of which classification system is used, it is essential that the system be used consistently across the healthcare team and be recorded appropriately in the patient’s records.
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