The Wagner Grade 3 Threshold: Where Diabetic Foot Ulcers Meet HBOT Coverage
Norm is 67, and he has a calendar full of things a wound on his foot keeps interrupting.
He has type 2 diabetes, a granddaughter with a spring recital, and is planning on a cruise to the Bahamas with the wife in a month.
For Norm, his ulcer is not an abstract classification problem. It is the reason he keeps ending up in exam room after exam room.
Over eight days, three clinicians will describe the same wound using two different classification systems and every one of them will be right.
Monday, March 2.
Norm has a routine diabetes follow-up with Dr. Campbell, his primary care physician. Blood pressure, weight, labs, and a comprehensive diabetic foot examination (CDFE). Questions about diet, exercise, sleep, stress, and any signs of high or low blood sugar.
Norm has had type 2 diabetes for nineteen years. His A1c is 8.4, down from 9.1. Dr. Campbell reviews his current medications, schedules a retinopathy screening, and refers him to podiatry.
The ulcer appears in a single line, most of the way down the note: left forefoot ulcer, daily dressing changes since February 6, offloading boot, completed ten days of cephalexin. Not improving.
It is the least specialized note of the three.
It is also the only one anywhere in Norm's chart that says what kind of diabetes he has.
Thursday, March 5.
Norm visits Dr. Perkins, DPM, the podiatrist Dr. Campbell referred him to. His wound measures 4.1 by 2.8 centimeters, depth 1.9. Moderate serosanguineous drainage. Periwound maceration. Slough across roughly forty percent of the bed, granulation across the rest. Photographs of his wound are attached to the record.
Dr. Perkins grades on the University of Texas Diabetic Foot Classification System. Norm’s wound is graded and staged 3-D.
Grade 3 is a wound penetrating to bone or joint.
Stage D is infection and ischemia, both are present.
Two characters, and an experienced reader knows most of what they need to know.
Dr. Perkins refers Norm to vascular.
Tuesday, March 10.
Norm visits Dr. Hopkins’ office, which is where Dr. Perkins referred him last Thursday. His pulses are non-palpable at the dorsalis pedis and posterior tibial arteries. His ABI is 0.62. Waveforms are monophasic.
The wound is staged on WIfI, per the Society for Vascular Surgery's system, built around Wound, Ischemia, and foot Infection. Norm’s wound is identified as a W2 I1 fI2.
W2 is a deeper ulcer, down to bone, joint, or tendon.
I1 is an ABI between 0.60 and 0.79.
fI2 is infection reaching past skin and subcutaneous tissue, with no systemic signs.
Impaired perfusion is flagged as a barrier to healing. Further imaging is recommended.
It is the most complete note in Norm’s record.
Three clinicians, three notes, two classification systems. Each note answers the question it was asked.
Then someone on the hyperbaric team opens Norm's chart and the question changes.
It’s no longer how bad is this wound. It is whether this patient, with a diabetic lower-extremity wound, after his course of care, meets a specific definition Medicare utilizes as coverage criteria for hyperbaric oxygen therapy (HBOT) — NCD 20.29. And that definition asks for something none of these three notes in Norm’s record was written to answer.
Vascular wrote W2 I1 fI2. Podiatry wrote grade 3, but not the grade 3 the criterion needs. Everything in Norm's chart points toward the threshold, but nothing in it establishes it.
There is one more thing worth noticing, and none of the providers in Norm’s story noticed it either.
Norm's first day of documented wound care started on February 6. Thirty days of it came and went on Sunday, March 8 — in the gap between his podiatry visit and his vascular consult, on a weekend, in a primary care record, while no one had any reason to be counting.
By the time vascular saw him, he was on day 32.
How Is a Diabetic Foot Ulcer Supposed to Be Graded?
Dr. Perkins used the University of Texas system. Dr. Hopkins used WIfI. Neither of them picked those classification systems at random, and neither of them was doing anything unusual.
The International Working Group on the Diabetic Foot (IWGDF) found 28 validated systems used to characterize foot ulcers in people with diabetes across 149 studies.¹ For every one of them, the certainty of the evidence came back low or very low.¹
And 19 of those 28 — roughly two-thirds — had been studied three times or fewer.¹
That is not a field that has settled on better tools. That is a field with more tools than evidence.
IWGDF narrowed that field to six by weighing accuracy, feasibility, equity, and cost: DIAFORA, IDSA/IWGDF, SINBAD, the University of Texas system, WIfI, and Wagner.² But making the short list is not the same as being recommended for clinical use.
From there, IWGDF did something genuinely useful. Rather than treating the validated systems as interchangeable, it sorted them by purpose.
Communicating about a wound between clinicians? Use SINBAD.² A patient with an infected ulcer? Use the IDSA/IWGDF infection classification.² Patient with peripheral artery disease? Consider WIfI.² Auditing outcomes across a population? SINBAD again.²
And for predicting what will happen to one specific patient's ulcer, use nothing at all. That one is a strong recommendation against — no currently available system, IWGDF concluded, is good enough to offer an individual prognosis.²
Which leaves the question of where Wagner landed.
It didn't. IWGDF states it plainly: DIAFORA, the University of Texas system, and Wagner "were not selected to be applied for clinical use or audits."²
Read next to the HBOT coverage criteria, the shape of Norm's problem comes into focus.
The current international guideline does not recommend Wagner for any clinical scenario. Medicare's national coverage determination for hyperbaric oxygen therapy, however, does require it.³
That is why a chart can read three different ways depending on who wrote the note. It is why a referral pathway from podiatry to a hyperbaric program can cross two classification systems before anyone reaches the one the payer named. And it is why a difference in clinical language can become a Medicare coverage problem.
So Why Is the Wagner Grading Scale Still Used in Hyperbaric Medicine?
Three answers, and they get better as they go.
Because Medicare Says So.
Medicare's national coverage determination for hyperbaric oxygen therapy lists fifteen covered conditions. The fifteenth is diabetic wounds of the lower extremities, and it carries three criteria.
The patient has type I or type II diabetes with a lower extremity wound due to the diabetes.³
AND
The patient has a wound classified as Wagner grade III or higher.³
AND
The patient has failed an adequate course of standard wound therapy.³
That language took effect on April 1, 2003.³
Because the Wagner Criterion Hasn't Been Reconsidered.
It is tempting to assume the criterion survived some formal review. That somebody compared Wagner with newer classification systems and decided it still served the purpose.
That never happened.
NCD 20.29 has been reconsidered exactly once since 2003, and that review was scoped to Section C, topical application of oxygen, and it removed that section entirely in 2017.³ Criterion 15, the diabetic lower-extremity wound provision, was not part of that reconsideration.
Everything else in the document's revision history is coding maintenance — ICD-9 to ICD-10 conversions and quarterly updates, each one stamped with the same note: no policy-related changes.³
So Wagner grade 3 has been the operative threshold for over twenty-three years, not because it was defended, but because the door was never opened.
Because the Wagner Grading Scale is Practical.
It would be easy to read all of that as a rule that fell behind. But IWGDF's assessment of Wagner is not what that story requires.
Wagner was rated accurate.²
On three separate measures of certainty, Wagner was the only one of the six rated "low" rather than "very low" — meaning the evidence behind it, while still weak, was the least weak of the group.²
It ties SINBAD as the most feasible system to actually use, and as the most equitable, because it requires no equipment beyond a clinical examination.² WIfI, by contrast, needs an ankle-brachial index at minimum, which IWGDF notes reduces both feasibility and equity.²
And it is the most validated system in the field. Of the 149 studies in IWGDF's review, 74 of them — half — assessed Wagner.² No other system comes close.
When Jeon and colleagues put five systems head to head against amputation risk in 137 patients, Wagner produced the highest area under the curve of the five.⁴ That result should be read carefully in both directions: it is a finding about Wagner, and it is equally a finding about the four newer systems it was measured against. IWGDF's own position is that none of them, Wagner included, is good enough to predict what will happen to an individual patient.²
So What is Wrong With the Wagner Grading Scale?
Not accuracy. Detail.
Wagner does not give infection or ischemia their own individual axis. It folds everything into a single ascending number.
Wagner is not wrong. It is coarse.
A Coverage Rule Needs a Threshold.
Here is where the two conversations diverge.
IWGDF is asking: How useful is this system for describing and managing a patient's wound?
Medicare is asking a different question: Does this wound cross the threshold named in the coverage rule?
Those are not the same job.
IWGDF also notes that the studies validating Wagner "focused mainly on the association between the different grades and amputation."¹ For a general-purpose clinical classification, that is a weakness. Association tells you very little about accuracy, reliability, or the patient in front of you.
But which grade is associated with amputation is not a weak question everywhere. It is precisely the question a coverage threshold has to answer.
A national coverage rule needs something that can be defined, documented, and adjudicated consistently. Wagner gives Medicare exactly that: grade III or higher.
The same body of evidence that makes the Wagner grading scale a less-than-optimal general-purpose classification tool makes it a usable threshold tool.
Which is Why Wagner is Still Used in Hyperbaric Medicine.
The rule does not stay inside the Medicare manual.
It travels.
Pam Sabet, DPM, practices in the Department of Wound Care and Hyperbaric Medicine at UC San Diego Health. Asked how staging drives her referrals, she describes wounds staged Wagner grade 3 or higher that have failed conventional wound care for 30 days as candidates for hyperbaric medicine consultation.⁵
That is not a billing rule being recited. That is a coverage criterion that has become clinical practice.
That is how a 2003 coverage threshold ends up shaping what gets written into a patient’s record, like Norm’s, in 2026.
So What Does a Wagner Grade Actually Mean?
Here is something strange about NCD 20.29.
The word "Wagner" appears in it exactly once.³
It appears in criterion 15(b), where it sets the threshold for coverage. And it is never defined. The document that requires a Wagner grade does not say what a Wagner grade is.
The definition lives somewhere else — in the decision memo CMS published in August 2002, eight months before the criterion took effect.⁶ That memo lays out all six grades in detail. It also states, in its own words, that it does not constitute a national coverage determination.⁶
So the operative definition of the threshold every hyperbaric program in the country documents against sits in a document that says, on its face, that it is not the rule.
Grades 0 Through 5, in Plain Terms
Here is how CMS defines them.
Grade 0 is a foot with no open lesion.⁶ The skin is intact. Something about the foot marks it as at risk, but there is no wound yet.
Grade 1 is a superficial ulcer. There is an open sore, and it has not gone through to the deeper layers.⁶
Grade 2 is deeper. The ulcer has penetrated to tendon, bone, or joint.⁶
Grades 0 through 2 all answer the same question: how deep is it? No lesion. Shallow lesion. Deep lesion. One ruler with three marks on it.
Grade 3 asks an entirely different question.
Grade 3 is a lesion that has gone deeper than grade 2 and has infection in it, an abscess, osteomyelitis, pyarthrosis, a plantar space abscess, or infection of the tendon and tendon sheaths.⁶
Depth alone does not make a wound a grade 3. Neither does infection alone. Grade 3 is both, together, and CMS names five specific findings that satisfy the second half.
Grade 4 is wet or dry gangrene in the toes or forefoot.⁶ Part of the foot has died.
Grade 5 is gangrene involving the whole foot, or enough of it that no local procedure will work and amputation at or above the below-knee level is indicated.⁶
What the Wagner Ruler Really Measures
Grades 0 through 2 measure depth.
Grade 3 adds infection.
Grades 4 and 5 measure the extent of gangrene.
Wagner is one ruler measuring three different numbers stacked on top of one another.
IWGDF makes the same point from a different angle: Wagner “does not include area, neuropathy, infection and peripheral artery disease individually,” and is “rendered blunt by the major impact of gangrene.”²
And it is exactly why the systems Norm's clinicians used are built differently. The University of Texas system separates depth from everything else — a number for how deep, a letter for whether infection and ischemia are present.⁴ WIfI goes further and grades the wound, ischemia, and foot infection independently.²
Wagner never separated them. That is the whole design.
Grade 2 is deep but clean. Grade 3 is deep and infected.
Everything below 3 is answering a depth question. Grade 3 is the first grade that asks whether something got into the wound.
Which is why Dr. Perkins' note said grade 3 and it still was not the grade 3 the coverage criterion needed. In the University of Texas system, grade 3 means the wound reaches bone or joint — a pure depth statement.⁴ Infection lives in the letter. Norm's stage D said infection was present.
Present is not the same as documented, named, and dated. And that distinction is where coverage is won or lost.
So Why Grade 3?
In a study of 137 patients with diabetic foot ulcers, researchers scored every wound on five different classification systems and followed what happened to the limb.⁴
At Wagner grade 2, 29.4% of those wounds ended in amputation. At Wagner grade 3? 87.5% did.⁴
The difference is not subtle.
A separate group in India followed 50 patients through stage-specific treatment and reported the same shape from a different angle: every amputation in the study occurred at Wagner grade 3 or above. None at grade 1 or 2.⁷
Two studies, different countries, different designs, six years apart. Both find the same cliff in the same place.
Read those numbers carefully, because they are small studies. The subgroups are thin, the confidence intervals are wide, and both were looking backward.⁴ ⁷ The step is the finding. The decimals are not. But the step is hard to miss — something changes between grade 2 and grade 3 that does not change anywhere else on the scale.
Which raises an obvious question. If that is where the cliff is, is that why the threshold is there?
Where the Threshold Came From
When CMS evaluated hyperbaric oxygen therapy for diabetic wounds in 2002, it reviewed two randomized controlled trials among a larger body of evidence.⁶
The stronger of the two was an Italian study of 68 patients, which CMS called the best designed and conducted study it reviewed.⁶ ⁹ That trial broke its results out by Wagner grade. It found a significant reduction in major amputation — at Wagner grade 4.⁶ ⁹
At grade 3, it did not. The grade 3 subgroup was four patients in one arm and eight in the other, and the difference was not statistically significant.⁶ ⁹ CMS said so directly, noting that the number of patients with less severe wounds was small and that outcomes like wound healing were not assessed at all.⁶
So the strongest evidence CMS had pointed at grade 4.
Grade 3 came from the other trial — a 30-patient study from India that randomized fifteen patients to hyperbaric oxygen and fifteen to standard care, and reported fewer positive wound cultures and fewer major amputations in the treated group.⁶ ⁸
That study never reported Wagner grades at all.⁸
CMS reasoned its way there. Because the wounds in that trial were infected and had abscesses drained, the agency concluded they were "at least Wagner grade III," and that the study therefore supported the use of hyperbaric oxygen at that grade.⁶
That inference is the origin of criterion 15(b).
What that Does and Does Not Mean
It does not mean hyperbaric oxygen therapy fails at Wagner grade 3. It means the evidence never isolated grade 3 well enough to answer the question.
The Italian trial's grade 3 arm had four patients in it.⁹ The Indian trial did not record grades.⁸ In the over twenty-three years since, no adequately powered trial has isolated that grade. What exists at grade 3 is an evidence gap, not a negative result — and those are very different things.
There is a postscript worth knowing. When IWGDF reviewed interventions for diabetes-related foot infection in 2020, it went looking for trials reporting infection-related outcomes for hyperbaric oxygen. It found exactly one: the same 30-patient study from 1992.¹⁰ Its assessment was that the trial's size and quality did not support a conclusion.¹⁰
So one small trial from 1992 is both the reason grade 3 sits in the American coverage rule and the reason the international guideline declines to draw a conclusion about it. The same trial, read by CMS in 2002 and by IWGDF in 2020.
Why 3 and not 4
In Jeon's analysis, the statistical dividing line fell between Wagner grades 3 and 4. The highest Youden's index occurred at a cutoff of 3.5, effectively separating the two grades.⁴
Medicare's coverage threshold sits at 3.
Those thresholds are not in conflict, because they answer different questions.
Jeon's cutoff came from a ROC analysis of how well the classification predicted lower-extremity amputation in a study population. Medicare's criterion determines when a diabetic lower-extremity wound qualifies for coverage of hyperbaric oxygen therapy.
A statistical cutoff can tell you where a classification best separates two outcomes. It does not tell you where a coverage rule has to be drawn.
Set the line at 4 and coverage begins at gangrene.
Set it at 3, and it begins at the moment the wound has reached the depth of grade 2 and infection reaches bone, joint, or tendon sheath — the point where the amputation curve turns upward and there is still a foot to save.
Which brings us back to Norm. His wound is almost certainly at or past that line and nothing in his chart establishes it.
Wagner Grade 3 Documentation Requirements
There are two different bars here, and almost every coverage problem in hyperbaric medicine lives in the gap between them.
Diagnosing osteomyelitis is a clinical act. A physician weighs the exam, the imaging, the labs, and makes a call.
Establishing Wagner grade 3 in the record is a documentation act. It asks whether that call — already made, already correct — appears in the chart in a form the coverage criterion recognizes.
Norm's clinicians did the first one. The second question was never asked.
One distinction matters here. Infection is part of the Wagner grade 3 definition, but infection itself is not the Medicare indication for HBOT. Criterion 15 covers HBOT as an adjunct for a non-healing diabetic lower-extremity wound that meets the coverage requirements. Standard wound care separately includes treatment of the infection.³ ⁶
At Wagner grade 3, infection is the severity marker. It is not the treatment target.
What Makes a Wound Grade 3?
CMS did not define grade 3 as "an infected deep wound." It named specific findings, and any one of them satisfies the infection half of the grade:⁶
abscess
osteomyelitis
pyarthrosis
plantar space abscess
infection of the tendon and tendon sheaths
A wound only has to walk through one.
The Shorthand is Narrower Than the Criterion
The five-system comparison study glosses Wagner grade 3 as “deep with osteitis.”⁴ The Indian observational study calls it “deep abscess formation or osteomyelitis.”⁷ IWGDF's one-line version says only “lesion involving deeper tissues” and does not mention infection at all.²
None of those summaries is wrong. But none of them carries the full set. The shorthand keeps abscess and osteomyelitis, while quietly dropping the rest.
That difference matters in Norm’s record.
Pyarthrosis (septic/infected joint) can qualify. So can an infected tendon sheath. Both are named explicitly in the CMS decision memo.⁶ Neither appears in the shorthand most people carry.
The most specific definition of Wagner grade 3 available anywhere is the one in the CMS decision memo.
Documentation Best Practices
Establishing each one looks different:
MRI carries a strong recommendation when the diagnosis remains in doubt after clinical findings, labs, and plain films.¹¹
A bone specimen is the generally accepted criterion standard — and the only definitive way to identify the organism.¹¹
Abscess, joint involvement, and tendon-sheath infection may be established through imaging or procedural documentation.⁶ ¹¹
The important part for the coverage record is simpler:
The finding.
The evidence that established it.
The date.
That's the chain.
Probe-to-Bone and Wound Cultures
Probe-to-bone is a useful test. Pooled across studies it runs about 0.87 sensitivity and 0.83 specificity.¹¹
The IWGDF guideline recommends using it as part of the initial evaluation for suspected osteomyelitis, alongside plain radiographs and inflammatory markers, and cautions that no single one of those findings can reliably establish or exclude osteomyelitis on its own.¹¹
The same distinction applies to superficial wound cultures. A swab can provide information about organisms on the wound surface, but IWGDF recommends tissue sampling for culture rather than a superficial swab when infection microbiology is needed.¹¹
The Clock Nobody is Watching
Now run Norm against NCD 20.29 coverage criterion 15 and the picture is not what you would guess.
Type 2 diabetes with a lower-extremity wound due to it? Documented in Dr. Campbell's note.³
Failed an adequate course of standard wound therapy? Daily dressing changes from February 6. Offloading boot. Antibiotics. Not improving. The thirtieth day passed on Sunday, March 8.³ Two days before he saw vascular. But the record that has to prove nothing was healing is one line in a primary care note and a single set of measurements taken three days early.
A wound classified as Wagner grade 3 or higher? Everything points there. Depth to bone or joint and infection present, recorded twice in two different systems by two different providers. And not one of CMS's required qualifying findings is named, dated, or tied to supporting evidence anywhere in Norm's record.
Not because the wound doesn't qualify. Because nobody was asked to establish that it does.
That is the ordinary shape of this problem. Not a missed diagnosis. Not careless documentation. Three correct clinical judgments, and a coverage question that none of them was written to answer.
What This Actually Costs
Norm is not a complicated case. And that? Is the point.
Everything in the record suggests the wound is at or beyond the clinical threshold in criterion 15. Wound depth and infection are documented twice. He meets the thirty-day clock. What is missing is not clinical severity. It is a named finding, tied to evidence, with a date on it, sitting somewhere a reviewer can find it.
What happens next in a hyperbaric program depends entirely on who opens that chart.
Someone who knows the criterion sees the gap immediately, picks up the phone, and asks Dr. Perkins or Dr. Hopkins specific questions: Was imaging taken? Was a culture obtained? Was the wound draining? If so, can we have the date? Often the answer is yes — something qualifying was already done. It exists in a record somewhere. It just never made it into the consult in a form a reviewer could follow.
That is what the chain is for. If Dr. Hopkins ordered an MRI on March 10 and it showed osteomyelitis of the second metatarsal head, that single sentence does what a pile of attached records cannot. It names the finding, names the evidence, and dates it — and it holds up whether the imaging lives in Epic, Intellicure, or a fax from across town.
Someone who doesn't know the criterion, though, sees a note with grade 3, assumes it is covered, and Norm starts therapy. Then the gap surfaces later during an audit, and it costs considerably more than a phone call.
Or the referral stalls. Nobody is quite sure, so nobody moves, and Norm goes back onto a schedule he was already trying to get off of.
That is not a clinical problem, and it is not solved by better medicine. Norm already received good medicine, three times, from three physicians who each did their job well.
It is a translation problem.
The information the coverage rule needs already exists in Norm's record. It is written in the vocabulary of vascular surgery, podiatry, and primary care, while the rule is written in the vocabulary of a 2002 decision memo.
Somebody just has to be able to read all four.
That is a learnable skillset. It is also a critical part of running a defensible hyperbaric program. The clinical judgment can be completely correct and still leave a coverage gap if nobody translates that judgment into the language the coverage determination requires.
Shared Health Services works directly with wound care and hyperbaric teams on exactly this problem: the documentation standards, the screening process, and the training that turns a correct clinical judgment into a record that holds up during an audit.
If your program is treating patients like Norm, the question is not whether your clinicians know what they are doing.
It is whether the chart says what the coverage rule needs it to say.
(800) 474-0202 · sales@sharedhealthservices.com
References
Monteiro-Soares M, Hamilton EJ, Russell DA, et al. Classification of foot ulcers in people with diabetes: a systematic review. Diabetes Metab Res Rev. 2024;40(3):e3645. doi:10.1002/dmrr.3645
Monteiro-Soares M, Hamilton EJ, Russell DA, et al. Guidelines on the classification of foot ulcers in people with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev. 2024;40(3):e3648. doi:10.1002/dmrr.3648
Centers for Medicare & Medicaid Services. National coverage determination (NCD) for hyperbaric oxygen therapy (20.29). Pub 100-3, §20.29. Version 4. Effective April 3, 2017; implemented December 18, 2017. Accessed September 11, 2026. https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=12
Jeon BJ, Choi HJ, Kang JS, Tak MS, Park ES. Comparison of five systems of classification of diabetic foot ulcers and predictive factors for amputation. Int Wound J. 2017;14(3):537-545. doi:10.1111/iwj.12642
Jakucs C. Diabetic foot ulcer classifications: the Wagner scale and the UT system. Wound Care Education Institute Blog. Published June 6, 2023. Updated January 7, 2026. Accessed September 11, 2026. https://blog.wcei.net/wagner-scale
Centers for Medicare & Medicaid Services. Decision memo for hyperbaric oxygen therapy for hypoxic wounds and diabetic wounds of the lower extremities (CAG-00060N). August 30, 2002. Accessed September 11, 2026. https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&NCAId=37
Shah P, Inturi R, Anne D, et al. Wagner's classification as a tool for treating diabetic foot ulcers: our observations at a suburban teaching hospital. Cureus. 2022;14(1):e21501. doi:10.7759/cureus.21501
Doctor N, Pandya S, Supe A. Hyperbaric oxygen therapy in diabetic foot. J Postgrad Med. 1992;38(3):112-114. PMID 1303408
Faglia E, Favales F, Aldeghi A, et al. Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. A randomized study. Diabetes Care. 1996;19(12):1338-1343.
Peters EJG, Lipsky BA, Senneville É, et al. Interventions in the management of infection in the foot in diabetes: a systematic review. Diabetes Metab Res Rev. 2020;36(S1):e3282. doi:10.1002/dmrr.3282
Senneville É, Albalawi Z, van Asten SA, et al. IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF/IDSA 2023). Diabetes Metab Res Rev. 2024;40(3):e3687. doi:10.1002/dmrr.3687
