IDSA Diabetic Foot Wound Classification

Aka: IDSA Diabetic Foot Wound Classification, IWGDF Diabetic Foot Ulcer Grading, Infectious Disease Society of America Diabetic Foot Ulcer Grading, International Working Group on the Diabetic Foot Ulcer Classification

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II. Indications

  1. Diabetic Foot Ulcer

III. Grading: Diabetic Foot Ulcer

  1. Grade 1: Uninfected
    1. No signs of infection (local or systemic)
  2. Grade 2: Mild Infection
    1. Skin or isolated subcutaneous involvement (no deeper tissue involved) AND
    2. Erythema does NOT extend >2 cm around the wound
  3. Grade 3: Moderate Infection
    1. Deep tissue involvement (tendon, Muscle, joint, bone) OR
    2. Erythema extends >2 cm around the wound
    3. Grade 3(O) denotes Osteomyelitis with moderate infection
  4. Grade 4: Severe Infection
    1. Systemic manifestations (see SIRS Criteria)
    2. Grade 4(O) denotes Osteomyelitis with severe infection

IV. Diagnosis: Infection criteria (Grades 2 to 4)

  1. Major criteria (requires at least 2 or more of the following)
    1. Local swelling or induration
    2. Erythema >0.5 cm surrounding the wound
    3. Local tenderness or pain
    4. Local increased warmth
    5. Purulent discharge
  2. No other identified inflammatory causes to explain the findings
    1. Gouty Arthritis
    2. Trauma (e.g. Contusion, Fracture)
    3. Venous Stasis
    4. Deep Vein Thrombosis
    5. Charcot Joint

V. References

  1. Nagendra (2022) Bacterial Infections in Diabetes, in Feingold, Endotext, South Dartmouth, accessed 4/21/2024
  2. Lipsky (2012) Diabetes Metab Res Rev 28(suppl 1): 163-78 [PubMed]

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