Foot Ulcer Stages
4 Levels of Foot Ulcer
Foot ulcers are open skin wounds that are usually slow to heal. They are most commonly seen in patients with diabetes and can be caused by several reasons such as trauma to the foot, peripheral neuropathy, and peripheral vascular disease. If not diagnosed and treated in time, foot ulcers can lead to the amputation of the lower limbs and foot. There are several methods to treat foot ulcers and the primary objectives of all treatment methods are basically obtaining closure of the wound, relieving pressure on the foot, eradication of infection and management of ischemia. These methods usually involve wound cleaning, appropriate dressings, debridement, use of antibiotics and advice on appropriate footwear, and insoles.
Most foot ulcers in diabetic patients remain largely hidden as they appear very small on the surface but in actual case they may extend deeper even into the bones. Depending on how deeply the ulcer has penetrated the layers of the skin, foot ulcers can be classified into four stages. These four foot ulcer stages are:
Stage 1 – Stage 1 ulcers are characterized by red skin over bony areas. The redness of the skin remains even after relieving the pressure over the area. You may also notice that the skin feel warm to touch.
Stage 2 – In stage 2, the skin over the affected area may develop cracks and blisters. The patients may have experienced loss of thicker layers of the skin, which involves the top two layers.
Stage 3 – At stage 3, patients develop broken skin that may look like a crater. There may sometimes be bloody drainage. The ulcer may have spread all the way into the bottom layers of the skin leading to full thickness skin loss that involves the tissue between the skin and muscles (subcutaneous tissue).
Stage 4 – This is most severe of all the stages. In this stage, the ulcer has spread deeper into the muscles, tendons, joints and bones causing a great deal of damage to the tissues in these areas. This stage often leads to infection in the bones, a condition known as osteomyelitis.
diabetic foot wound
Diabetic foot ulcers are classified into grades of 0 to 5 according to the Wagner wound classification system, which is the most widely used system. This system classifies the ulcers based on how deep they have penetrated the skin and occurrence of osteomyelitis, gangrene and tissue death.
The five grades of foot ulcer as per the Wagner system are as follows.
- Grade 1 – These are superficial ulcers that may extend over the partial or sometimes the full thickness of the skin.
- Grade 2 – In this case, the ulcers may spread over the ligaments, tendons, joints or the fibrous connective tissue that separate or holds together the muscles.
- Grade 3 – Grade 3 ulcers penetrate deep into the skin leading to bone infection (osteomyelitis) and/or joint sepsis.
- Grade 4 – Grade 4 ulcers involve decay of tissues in the forefoot or heel regions of the foot, a condition called gangrene.
- Grade 5 – This stage involves gangrene that has spread over a wide area.
These classifications into different foot ulcer stages or grades are highly beneficial as it helps in the proper examination coupled with prompt and appropriate treatment of the condition. This would help to bring down the risks of limb amputations to a great extent.