Diabetic foot ulcers can cause pain and discomfort for patients with diabetes. They can also cause serious complications such as infection or amputation. Recognizing the early signs of an ulcer and seeing a diabetic foot care specialist can prevent severe problems from developing and help get you proper treatment. There are several classification systems used for diabetic foot ulcers that identify the stage of the ulcer in order to select the appropriate treatment. Classifying diabetic foot ulcers

Diabetic Foot Ulcer Symptoms

Many diabetic patients have a loss of sensation in their feet, so an injury can occur to the bottom of the foot and not be noticed. If that injury develops into an open sore and goes untreated, it can become infected and cause serious complications. Some signs of a diabetic foot ulcer are:

  • Drainage or blood on your socks
  • Swelling
  • Redness
  • Foul odor

As a foot ulcer worsens, infection can develop and spread to surrounding bone and tissue. Black tissue can form around the ulcer, and gangrene can result and cause death to the tissue, foot pain, and numbness. If the infection cannot be controlled, amputation may be needed to save the patient’s life.

Classification Systems for Diabetic Foot Ulcers

If you notice signs of a foot ulcer, contact a podiatrist for an evaluation. To grade the severity of the ulcer and determine the proper type of treatment, a podiatrist uses a classification system. Most systems are based on the size, location, and depth of the wound and used as an assessment tool for treatment. There are various classification systems used by podiatrists, including:

Wagner Ulcer Classification System

The Wagner Ulcer Classification System is based on the depth of the wound and uses a scale of 0 to 5 to rate the severity of the ulcer. The following ratings characterize the wound:

  • 0 rating is given if there are no open sores or if the ulcer has healed
  • 1 rating is given if the ulcer is superficial and has not penetrated the deeper layers of skin
  • 2 rating is given if the ulcer is deeper and extends to the tendon, bone, or joint capsule
  • 3 rating is given if the ulcer has affected the deeper skin tissue and there are other issues present such as an abscess, osteomyelitis, or tendonitis
  • 4 rating is given when there is gangrene in the area of the heel or forefoot
  • 5 rating is given when gangrene affects the entire foot

University of Texas Diabetic Foot Ulcer Classification System

Another system podiatrists use to classify foot ulcers is the University of Texas Diabetic Foot Ulcer Classification System. This system is used to determine how deep the ulcer has penetrated the skin using a scale of 0 to 3 and wound severity using stages A to D. The deeper the wound and whether there is presence of infection and ischemia, the higher the grade and stage.

Other Foot Ulcer Classification Systems

In addition, there are other systems that can be used to classify a diabetic foot ulcer, including:

  • Diabetic Ulcer Severity Score (DUSS). DUSS categorizes foot wounds into specific subgroups and gives points to determine the severity based on a scale of 0 to 4. The presence of pedal pulses, probing to bone, and location of the ulcer are used for assessment.
  • Site, Ischemia, Neuropathy, Bacterial Infection, and Depth (SINBAD) Wound Classification System. SINBAD gives grades to clinical features such as site area, ischemia, neuropathy, bacterial infection, and wound depth. Ulcers that are less severe get a score of less than 3. Ulcers that are more severe get a score of 3 or more with a maximum of 6.
  • SAD Classification System. SAD bases it classification on elements such as size, area, depth, infection, ischemia, and neuropathy.
  • PEDIS Classification. The International Working Group of the Diabetic Foot created PEDIS to classify foot ulcers. It does not take ulcer location into consideration but uses elements such as size, depth, infection, ischemia, and neuropathy.

Are You Experiencing Foot & Ankle Pain in Alexandria, VA?

If you are looking for an expert on neuropathy,you should reach out to an experienced podiatrist. Foot pain is never something you just have to put up with. If your feet are aching, out of alignment, or just aren't holding up to the wear and tear of modern living, Capital Podiatry Associates can help. Our office provides a wide variety of advanced, effective treatment options for all kinds of painful conditions. Ready to schedule an appointment? We offer telemedicine and valet medicineContact us online or call our Alexandria office at 703-560-3773.


Leland T. Gilmore, DPM
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Dr. Leland Gilmore is a compassionate and experienced foot and ankle specialist.
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