No single “staging” system for diabetic foot suits every person or purpose. Different classifications are used for wound depth, infection severity, circulatory risk and communication between teams.
Classification is not based solely on a photograph and does not independently predict individual healing or amputation outcomes; clinical examination and infection and circulation assessment are needed.
- An explicitly named system for wound depth
- IWGDF/IDSA severity classification for infection
- WIfI for circulatory risk
- SINBAD for team communication
Wagner classification (simplified)
The Wagner system describes wound depth and gangrene on a scale of 0–5; this page only introduces the system and does not predict individual outcomes.
- Grade 0: Skin is not open, but deformity, calluses or pre-ulcerative risk signs may be present
- Grade 1: Superficial ulcer
- Grade 2: Deep ulcer that may extend to tendon, capsule or bone
- Grade 3: Ulcer associated with abscess, osteomyelitis or deep infection
- Grade 4: Gangrene in part of the foot
- Grade 5: Gangrene affecting a large part of the foot
Infection severity is classified separately
In the IWGDF/IDSA system, clinical infection is classified as uninfected, mild, moderate or severe. Fever, poor circulation, deep tissue involvement and general condition influence this assessment.
Different tools for circulation and communication
In people with peripheral artery disease, WIfI may help discuss vascular risk and the benefits of revascularization. SINBAD may be used to communicate wound information consistently between teams.
Classification is not prognosis
No classification system alone can definitively predict individual healing time or amputation probability. Treatment decisions consider the wound, infection, circulation, pressure and general health together.
Blackening or rapid deterioration is an emergency
If the foot turns black, redness spreads rapidly, fever develops or general condition deteriorates, call 112 or go to the nearest emergency department.
Related content
Scientific sources
This information is for general education. The assessment and treatment appropriate for you are determined by a medical examination.
