Since foot ulcers are easier to treat in the initial stages before serious complications can develop, it is important to contact an experienced podiatrist familiar with diabetic foot care as soon as possible. To determine the correct treatment for a foot ulcer, a podiatrist may use a classification system that establishes the severity or “stage” of the wound. Classifying foot ulcers

Common Signs of a Foot Ulcer

Patients with diabetes often experience a loss of sensation or poor circulation in their feet. Because of this, an injury to the bottom of the foot can often go undetected and turn into an open wound. If the wound is left untreated, it can become infected and cause serious problems. So, it’s important to be aware of the signs and symptoms of a diabetic foot ulcer.

Watch for These Signs of a Diabetic Foot Ulcer

  • Blood stains or drainage on your socks
  • Redness and swelling
  • Foul odor from your foot
  • Black tissue around the wound

Classifying Diabetic Foot Ulcers

When determining the type of treatment for a diabetic foot ulcer, a podiatrist may use a classification system to grade the severity of the wound. Many of the systems used by podiatrists are tools that grade the ulcer based on size, depth of the wound, and location.

Wagner Ulcer Classification System

The most commonly used classification system is the Wagner Ulcer Classification System. This grading scale helps the podiatrist evaluate an ulcer based on the depth of the wound, using a 0 to 5 ranking:

  • 0: There are no open sores or lesions present, or the ulcer has healed.
  • 1: The ulcer is superficial and has not penetrated to the deeper layers of the skin.
  • 2: The ulcer is deeper and reaches a tendon, bone, or joint capsule.
  • 3: The ulcer has reached deeper tissue, and there may be other issues such as an abscess, osteomyelitis, or tendinitis.
  • 4: There is gangrene in a portion of the forefoot or in the area of the heel.
  • 5: Gangrene has spread to the entire foot. At this stage, amputation is often the only option to save a person’s life.

University of Texas Diabetic Foot Ulcer Classification System

Podiatrists also use the University of Texas Diabetic Foot Ulcer Classification System to help diagnose the seriousness of a foot ulcer. This system uses a scale of 0 to 3 to establish the depth of the ulcer and A to D to establish the wound’s severity based on the presence of infection and/or ischemia.

Site, Ischemia, Neuropathy, Bacterial Infection, and Depth (SINBAD) Wound Classification System

The SINBAD classification system grades six clinical features of a foot ulcer using a 0 or 1 scale up to a maximum score of 6 points.

  • Site
  • Ischemia
  • Neuropathy
  • Bacterial infection
  • Area
  • Ulcer depth

Diabetic Ulcer Severity Score (DUSS)

DUSS categorizes wounds into specific subgroups and gives points to determine the severity based on a score ranging from 0 to 4. Categories used for assessment include:

  • Presence of pedal pulses
  • Ability to probe to bone
  • Ulcer quantity and location

SAD Classification System

The SAD classification system scores ulcer features on a scale from 0 to 3:

  • Size, including the area and depth 
  • Infection
  • Ischemia
  • Neuropathy

Other Classification Systems

  • PEDIS classification system. PEDIS uses five elements to grade an ulcer: perfusion, extent, depth, infection, and sensation.
  • DEPA classification system. DEPA uses four categories to grade a foot ulcer. These are depth, bacterial colonization, phase of healing, and associated etiology. Each category is given a rating from 1 to 3 depending on the severity.

Prevention and Foot Ulcer Treatment Options

Taking good care of your feet is an important part of diabetes management. While not every foot ulcer can be prevented, there are many ways you can help keep your feet healthy.

How to Keep Diabetic Feet Healthy

  • Do a daily self-check of your feet to look for signs of a foot ulcer or other abnormality.
  • Wash your feet with warm water and mild soap, making sure to completely dry them afterward.
  • Never soak your feet in hot water for long periods of time.
  • Trim your toenails straight across to prevent injury.
  • Wear clean, dry socks to protect your feet.
  • Never attempt to remove corns or calluses at home.
  • See a podiatrist at the first sign of a foot problem.

If you develop a foot ulcer, there are a variety of treatment options that your podiatrist may recommend.

Treatment Options for Diabetic Feet

  • Rest
  • Elevation
  • Taking weight off the affected foot
  • Changing the type of footwear you wear

In more severe cases, debridement may be done to remove dead tissue and debris from the wound to promote healing. For some patients, surgery may be needed, and in cases where infection cannot be controlled, amputation may be needed to save the person’s life.

Are You Looking For Diabetic Foot Care in Austin, TX?

If you are looking for diabetic foot care, you should reach out to an experienced podiatristAustin Foot and Ankle Specialists can help. Our office provides a wide variety of advanced, effective treatment options for all kinds of painful conditions. Ready to schedule an appointment? Contact us online or call our Austin office at 512.328.8900.


Craig Thomajan
Connect with me
Austin Podiatrist