The goal of developing this system was to guide healthcare professionals, from primary care to the emergency room, in the generalized management of patients with DF who have suspected Charcot neuroarthropathy or foot ulcers, enabling them to act quickly [11] and thus maximize their chances of avoiding complications or the need for amputation.

Our system was not intended to be compared to other published classifications; it simply aims to offer a new tool for the management of this health problem, and has proven very useful in our DFU for a long period of time. As part of our tool comprises wound classification, we wanted to discuss the other most commonly used classifications currently used. In the scales published to date, certain essential aspects of clinical management have not been considered. For example, the wound depth, ischemia, and foot infection (WIFI) system [12] is a good option for assessing the level of ischemia and the benefit of revascularization; however, it does not include neuropathy, ulcer location, or ulcer extension. The International Working Group on Diabetic Foot (IWGDF) [13] classification only considers infection and does not assess other parameters that are important for the prognosis of ulcers—such as ischemia, neuropathy, location, depth, and extension of the ulcer. Although the University of Texas classification [14] is commonly used, it does not consider neuropathy or ulcer areas, which are major determinant of healing. Perfusion, extent, depth, infection, and sensation (PEDIS) [15] may be the most complete, although it is not easy to use in daily clinical practice and is most appropriate for determining the inclusion and exclusion criteria for research projects [8, 16]. The IWGDF currently recommends using the site, ischaemia, neuropathy, bacterial infection, area, and depth (SINBAD) classification because it includes the largest number of ulcer characteristics, and because it is a simple scoring system that is easy to use by any specialist. However, it does not provide 100% specific information on lesion characteristics, which is why it has been criticized for being insufficient [9].

The involvement of a multidisciplinary team can improve the prognosis of DF [17, 18]. Coordination between departments that care for patients with DF is therefore essential for its proper management.

Because these patients must be treated by a multidisciplinary team, unifying all variants in a single document, and considering the most appropriate level of care at each time point, makes handling their cases easier.

In many countries, the first contact between a patient and the health care system is through primary care [1]—which is often responsible for prevention, early detection, or referral to secondary level.

Our novel system is a tool that facilitates coordinated work among multidisciplinary teams to achieve the comprehensive management of patients with DF and decrease major amputation rates. In HUMT, between 2003 and 2012 when the system was first adopted, major amputations decreased by 67%—from 34 major amputations in 2003 to 11 in 2012. In HUGTP, from 2013–2021, the number of major amputations decreased from 153 (2010–2014) to 71(2015–2020) [10, 19].