Wagner-Meggitt Classification of Diabetic Foot Ulcers
Classic 6-grade classification of diabetic foot ulcers based on depth and ischaemia (Meggitt 1976; Wagner 1981). Drives debridement, antibiotic and amputation decisions. Complemented by University of Texas system (which also grades infection and ischaemia).
Score interpretation
→ Education, daily inspection, podiatry, off-loading footwear. Annual diabetes foot screen per NICE NG19.
→ MDT diabetic foot service per NICE NG19. Off-loading (total contact cast or removable cast walker), local wound care, optimise glycaemia, treat infection if signs (localised cellulitis: flucloxacillin).
→ Diabetic-foot MDT urgently. Probe-to-bone test; X-ray ± MRI to exclude osteomyelitis. IV antibiotics (cover S. aureus + streptococci ± Gram-negatives if chronic). Vascular assessment (ABPI, duplex).
→ Admit. Surgical debridement of infected bone; bone biopsy for culture. IV broad-spectrum (e.g. piperacillin-tazobactam) → narrow per culture; ≥4–6 weeks if osteomyelitis. Revascularise if PAD. Multidisciplinary input.
→ Urgent vascular assessment for revascularisation; if not feasible, partial amputation (toe, ray). Optimise glycaemia, nutrition. Wound healing typically prolonged — follow-up in MDT clinic.
→ Major amputation (below-knee) usually required; multidisciplinary preoperative optimisation. Pre-prosthetic rehabilitation planning. Mortality 5-year >50% — discuss prognosis.
Interpretation bands for the Wagner-Meggitt. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Esomeprazole (Burns — Curling's Ulcer Prophylaxis) · Proton Pump Inhibitor — Stress Ulcer Prophylaxis
- Finerenone · Non-Steroidal Mineralocorticoid Receptor Antagonist (Diabetic CKD)
- Atrasentan · Selective Endothelin-A Receptor Antagonist (Diabetic Nephropathy)
- Bosentan · Endothelin Receptor Antagonist (ERA) — Pulmonary Arterial Hypertension / Digital Ulcers
- Treprostinil · Prostacyclin Analogue — Pulmonary Arterial Hypertension / Digital Ulcers
- Diabetic Ketoacidosis (DKA) · JBDS 2013 / Joint British Diabetes Societies; NICE NG17
- Adult Hypoglycaemia (Treated Diabetes) · JBDS-IP (2023): Hospital Management of Hypoglycaemia
- Adrenal Crisis · Society for Endocrinology Emergency Guidance (2024)
- Type 2 Diabetes Management · NICE NG28 2022
- Hyperthyroidism Management · BTA / ETA 2018
- Adrenal Insufficiency · Society of Endocrinology / ESE 2016
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.