What does a Wagner Grade 4 Look Like?
- mdavis107
- Oct 15, 2020
- 2 min read
Updated: 3 days ago
Wagner Grade 4 diabetic foot ulcers involve localized gangrene affecting the toe, forefoot, or multiple toes. The tissue death may appear wet (with swelling, odor, discharge, and infection) or dry (blackened, mummified, and hard).
Clinical Significance
This level of ulceration represents a critical threat to limb viability. Immediate medical intervention is essential to avoid progression to Grade 5, where full-foot gangrene occurs. Treatments at this stage often include:
Surgical debridement
Partial toe or forefoot amputation
Broad-spectrum antibiotics for infection
Vascular studies or revascularization procedures
Adjunctive therapies like hyperbaric oxygen therapy (HBOT) following surgical care
Common Risk Factors
Patients who develop Wagner Grade 4 ulcers frequently present with:
Prolonged, uncontrolled diabetes
Peripheral arterial disease (PAD)
Diabetic neuropathy
Delayed intervention at earlier wound stages
Visual Examples of Wagner Grade 4
Below are real-world images representing the appearance of Wagner Grade 4 diabetic foot ulcers. These are graphic but important visual references for clinicians, caregivers, and patients to identify the severity and act quickly.





When to Refer
If a patient presents with signs of gangrene, referral to a wound care and limb preservation team is crucial. Delay can lead to higher-level amputation and systemic complications.
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