By George Theodorakopoulos BSc RN BSc Podiatry MSc MBA MSc MSc(c) and David G Armstrong DPM MD PhD
DOI: 10.56885/748399pmrtwk
Abstract: Diabetic foot ulcers (DFUs) remain a leading cause of hospital admission, limb loss and reduced life expectancy in patients with diabetes, often carrying a prognosis as severe as many common cancers. Despite established guidelines, the complexity of managing these wounds—compounded by neuropathy, ischemia and infection—can lead to fragmented care and delayed interventions. This article proposes a practical framework for limb preservation organized around the Society for Vascular Surgery’s WIfI (Wound, Ischemia, and foot Infection) classification system. We define a WIfI-guided approach not just as a staging tool, but as a clinical mindset that dictates urgency and prioritizes three core domains: offloading, debridement/wound hygiene and perfusion optimization. By mapping standard interventions—such as nonremovable offloading devices and point-of-care fluorescence imaging—to the WIfI components, clinicians can better recognize early signs of deterioration. This framework emphasizes that advanced therapies should only be introduced once this foundational care is optimized. Ultimately, utilizing WIfI-guided triage helps multidisciplinary teams communicate more effectively, react faster to changes in the wound be and move toward a more proactive model of amputation prevention.