Which Classification Systems Are Most Useful for Diabetic Foot Ulcers in Different Clinical Settings? A Comparative and Practical Review
10.14193/jkfas.2026.30.2.49
- Author:
Jiyoun KIM
1
;
Sooyong LEE
Author Information
1. Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
- Publication Type:Review Article
- From:Journal of Korean Foot and Ankle Society
2026;30(2):49-54
- CountryRepublic of Korea
- Language:English
-
Abstract:
Diabetic foot ulcers (DFUs) are a critical complication of diabetes associated with a high risk of amputation and mortality. Despite the availability of numerous classification systems, the clinical outcomes remain suboptimal because of the complex pathophysiology of DFU and the lack of a universally applicable approach across different healthcare settings. This review compares the major DFU classification systems and proposes a practical framework to support clinical decision-making according to the disease stage and institutional capacity. A comparative analysis was performed on major DFU classification systems, including the Wagner; University of Texas (UT);Perfusion, Extent/size, Depth/tissue loss, Infection, and Sensation (PEDIS) classification; Site, Ischemia, Neuropathy, Bacterial Infection, Area, and Depth (SINBAD) classification; and the Society for Vascular Surgery (SVS) Wound, Ischemia, and foot Infection (WIfI) systems. Their strengths and limitations were evaluated based on their clinical applicability, prognostic value, and usefulness in different healthcare environments. Although the Wagner and UT systems offer clinical convenience for initial assessment and monitoring, they do not provide sufficient detailed information for complex surgical planning. By contrast, the WIfI classification provides a more precise prediction of the amputation risk and revascularization benefit, even though it requires an objective vascular assessment that may not be readily available in primary care settings. This study introduces a “Scenario-based Stepwise Escalation Framework” to resolve “classification fatigue.” This model uses SINBAD/Wagner for initial screening, UT/PEDIS for specialized management, and WIfI for advanced surgical interventions and revascularization. The optimal classification strategy for DFU should be selected flexibly based on the clinical stage of the disease and the diagnostic capabilities of the treating institution. Rather than recommending a single universal classification system, this review supports the complementary use of multiple systems according to specific clinical needs. A stage- and setting-based approach may facilitate multidisciplinary communication and assist clinical decision-making in DFU management. Future prospective studies will be needed to validate the clinical effectiveness of the proposed framework.
