A 65-year-old diabetic man presents with a painless ulcer under the 1st metatarsal head (plantar surface) with surrounding callus. Probe to bone test is positive. Foot radiograph shows bony destruction of the 1st metatarsal head with preserved skin integrity proximally. According to the Wagner classification, this ulcer is:
- A Wagner Grade 3 — deep ulcer with osteomyelitis or abscess ✓
- B Wagner Grade 0 — pre-ulcerative callus, no open lesion
- C Wagner Grade 2 — deep ulcer penetrating to tendon, capsule or bone
- D Wagner Grade 4 — gangrene of the forefoot
Explanation
Wagner classification of diabetic foot ulcers: Grade 0 (intact skin, callus); Grade 1 (superficial ulcer); Grade 2 (deep ulcer to tendon/capsule/bone without osteomyelitis); Grade 3 (deep ulcer with osteomyelitis, septic arthritis, or deep abscess); Grade 4 (partial gangrene forefoot); Grade 5 (whole foot gangrene). A positive probe-to-bone test is highly specific for osteomyelitis (specificity ~89%), and bony destruction on X-ray confirms osteomyelitis — this is Wagner Grade 3. Grade 3 typically requires IV antibiotics and surgical debridement, often with partial ray amputation.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.