A diabetic ulcer on the foot is one of the most common complications of diabetes affecting approximately 19% to 34% of people with the metabolic disorder. Ulcers can develop anywhere on your feet or toes and left untreated, can lead to severe infections that may result in amputations. The most common causes are nerve damage, wounded feet, poor circulation and high blood sugar.
When assessing and documenting a diabetic ulcer, most clinicians use a classification system. The correct grading is necessary so they can provide the most appropriate and effective treatment for the best results. Earlier diagnosis and treatment are essential to avoid serious complications down the road.
Several classification systems are commonly used today because there is no universally accepted standard. One of the most well-established is the Wagner Scale which was developed in the 1970s. It encompasses six ulcer grades from 0 to 5.
Grade 0: The skin is intact, and although an ulcer cannot be seen or felt, it may be there. You may feel discomfort or pain, and there could be a bone deformity. The best course of action for people at Grade 0 is to minimize the risks of further damage to the foot. This may include stopping some physical activities, resting more and visiting a healthcare provider for information on preventing ulcers from worsening.
Grade 1: There is a superficial ulcer of the skin which is easily recognizable. It may be a small opening or a cut involving the full skin thickness, although it does not extend to the subcutaneous layer. The bone or joints are not involved. At this stage, a person will feel some kind of pain. Dressing the wound and keeping it clean to prevent infection is key here.
Grade 2: The ulcer extends into the ligament, tendon, joint capsule or even muscles. It is deep, painful and oozes blood and pus. Keep the wound safe to prevent infection and visit your doctor regularly. Patients do not need to go into hospital at this stage.
Grade 3: This is similar to the previous stage, but the diabetic ulcer on the foot has opened up deeper, and infection may already have kicked in. A hospital stay might be required so doctors can observe the wound.
Grade 4: There is partial foot gangrene (a type of tissue death). There is a risk that the gangrene could spread and kill surrounding living cells. Treatments include antibiotics to deal with the infection and surgery to cut out the dead tissue (known as debridement).
Grade 5: There is extensive gangrene covering the whole foot. Amputation may be considered to prevent it from spreading to other parts of the body.
Among the other diabetic foot ulcer classification systems are:
This system uses four grades and stages them with the presence or absence of infection and ischemia (a restriction of blood supply to tissues).
Grade 0: A healed pre-or post-ulcerative site - with infection/with ischemia/with infection and ischemia
Grade 1: A superficial wound that doesn't involve tendon, bone or joint capsule - with infection/with ischemia/with infection and ischemia
Grade 2: An ulcer that has penetrated to the tendon or joint capsule - with infection/with ischemia/with infection and ischemia
Grade 3: A diabetic ulcer on the foot that has penetrated to the bone or joint - with infection/with ischemia/with infection and ischemia
Typically, doctors develop a treatment plan according to the size, depth, location of the ulcer as well as the presence or absence of infection or ischemia.
If you have an ulcer and your doctor suspects it's at risk of serious infection, they may prescribe antibiotics, antiplatelets or anticlotting medications. Other treatments include:
If you have diabetic ulcers on your feet or think you may be at risk of developing them, contact the experts at the Midwest Institute for Non-Surgical Therapy (MINT). Our podiatrists will examine your feet and come up with the best course of treatment for your situation. To make an initial consultation, use our online booking service today.