Answer a few guided questions to determine the Wagner grade (0–5) of a diabetic foot ulcer — with definitions and what each grade implies.
Clinical decision support only — not a diagnosis. Wagner grades 3–5 need urgent specialist evaluation. Always use clinical judgment and local protocol.
| Grade | Definition |
|---|---|
| 0 | Intact skin; high-risk foot (deformity, neuropathy, or prior ulcer) but no open lesion. |
| 1 | Superficial, full-thickness ulcer not extending beyond the dermis. |
| 2 | Deep ulcer penetrating to ligament, tendon, joint capsule, or bone — without abscess or osteomyelitis. |
| 3 | Deep ulcer with abscess, osteomyelitis, or joint sepsis. |
| 4 | Partial-foot gangrene. |
| 5 | Whole-foot gangrene. |
Higher grades carry sharply higher risks of hospitalization and amputation, which is why accurate grading at first presentation matters — it sets the urgency of referral, offloading, vascular assessment, and infection workup.
Grade 0: intact skin but high-risk foot. Grade 1: superficial full-thickness ulcer. Grade 2: deep ulcer to tendon, ligament, joint capsule or bone, without abscess or osteomyelitis. Grade 3: deep ulcer with abscess, osteomyelitis, or joint sepsis. Grade 4: partial-foot gangrene. Grade 5: whole-foot gangrene.
A Wagner grade 2 ulcer extends deep to ligament, tendon, joint capsule, or bone (it can be probed to these structures), but without abscess, osteomyelitis, or joint infection.
Grade 2 is a deep ulcer without deep infection. Grade 3 adds deep infection: abscess, osteomyelitis (bone infection), or joint sepsis. Grade 3 requires more urgent management.
Ulcers with spreading infection, gangrene, or suspected osteomyelitis (Wagner grades 3–5) need urgent specialist evaluation. Any rapidly worsening foot ulcer in a diabetic patient warrants prompt assessment.
Reviva's foot assessments document DFU grade, photos, and offloading at every visit, so grade changes never go unnoticed.
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