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Table 1.

Classification of diabetic foot infections

GRADE 1 No symptoms or signs of infection
GRADE 2 Infection involving the skin and the subcutaneous tissue only (without involvement of deeper tissues and without systemic signs as described below). At least two of the following signs are present:
•Local swelling or induration
•Erythema >0·5–2 cm around the ulcer
•Local tenderness or pain
•Local warmth
•Purulent discharge (thick, opaque to white secretion). Other causes of an inflammatory response of the skin should be excluded (e.g. trauma, gout, acute Charcot neuro‐osteoarthropathy, fracture, thrombosis and venous stasis)
GRADE 3 Erythema >2 cm plus one of the signs described above (swelling, tenderness, warmth, discharge) OR
Infection involving structures deeper than skin and subcutaneous tissues such as abscess, osteomyelitis, septic arthritis and fasciitis
No systemic inflammatory response signs as described below
GRADE 4 Any foot infection with the following signs of a systemic inflammatory response syndrome (SIRS). This response is manifested by two or more of the following conditions:
•Temperature >38°C or <36°C
•Heart rate >90 beats/minute
•Respiratory rate >20 breaths/minute
•PaCO2 <32 mmHg
•White blood cell count >12·000 or <4·000/mm3
•10% immature (band) forms

Adapted from (17) with permission from IDF Consultative Section on the Diabetic Foot/IWGDF. Copyright © 2003, IDF Consultative Section on the Diabetic Foot/IWGDF. All rights reserved.