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The diabetic foot wound classification systems that have previously been described in the medical literature either do not provide information about some of the most important parameters that would be expected to dictate treatment and predict outcome, or they are incompletely used in the grading scheme. Most classification systems primarily focus on the depth of the ulceration and neglect or inconsistently include infection and peripheral arterial occlusive disease.

We have observed that poor outcomes are often associated with wounds of increasing depth, increasing severity of infection, and presence of peripheral vascular disease. These factors have been widely discussed in the literature. The following classification uses a system of wound grade and stage to categorize wounds by severity. Wounds are graded by depth. Grade 0 represents a pre- or post-ulcerative site. Grade 1 ulcers are superficial wounds through the epidermis or epidermis and dermis but do not penetrate to tendon, capsule or bone. Grade 2 wounds penetrate to tendon or capsule. Grade 3 wounds penetrate to bone or into a joint. Within each wound grade there are four stages: clean wounds (A), non-ischemic infected wounds (B), ischemic wounds (C), and infected ischemic wounds (D).

The system is conceptually simple. The clinician begins by asking one question: How deep is the wound? This is answered by wound grades 0-3.

Secondly, the clinician asks: Is it clean, infected, ischemic or both? These queries are answered in wound stages AD.

Adapted from: Armstrong DG, Lavery LA, Harkless LB. Validation of a Diabetic Wound Classification System:

The contribution of depth, infection and ischemia to risk of amputation,

Diabetes Care, 21:855-859, 1998.