Hi Melissa,
Here are some combined thoughts from a few of our editors - other colleagues might have additional input as well.
Given the information shared, it’s possible that the patient has a pressure injury on the heel. If the patient does not have diabetes, the ulcer could be classified using the NPIAP Staging System.
For patients with diabetic foot ulcers, the Society for Vascular Surgery recommends using the WIfI Classification System (Wound, Ischemia, and foot Infection), which offers a more quantitative assessment of vascular status. However, the Wagner Classification system would be required by CMS when evaluating if the patient is a candidate for HBOT.
With this in mind:
If a diabetic patient has a heel ulcer covered with eschar, the ulcer would not be classifiable using the Wagner system until the wound bed can be assessed.
Gangrene (Wagner Grades 4 or 5) refers to actual tissue death due to critical ischemia or infection - not just the presence of eschar.
If there’s concern for infection, an MRI could be helpful to evaluate for deep abscess, osteitis or osteomyelitis, pyarthrosis, plantar space abscess, or tendon sheath infection. If any of these are present, it would be classified as a Wagner Grade 3 diabetic foot ulcer even with an eschar covering the wound.
Alternatively, if the patient is not at risk for infection or gangrene, one could wait once the eschar falls off and the wound bed can be assessed, so that the Wagner classification could be used.
Hope this helps!
Resources:
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