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This systematic review is part of the process of developing the 2023 guidelines to classify foot ulcers from the International Working Group on Diabetic Foot.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched PubMed, Scopus and Web of Science for articles published up to December 2021 which evaluated the association, accuracy or reliability of systems used to classify ulcers in people with diabetes. Published classifications had to have been validated in populations of &gt;80% of people with diabetes and a foot ulcer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We found 28 systems addressed in 149 studies. Overall, the certainty of the evidence for each classification was low or very low, with 19 (68%) of the classifications being assessed by \u2264 3 studies. The most frequently validated system was the one from Meggitt\u2010Wagner, but the articles validating this system focused mainly on the association between the different grades and amputation. Clinical outcomes were not standardized but included ulcer\u2010free survival, ulcer healing, hospitalisation, limb amputation, mortality, and cost.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite the limitations, this systematic review provided sufficient evidence to support recommendations on the use of six particular systems in specific clinical scenarios.<\/jats:p><\/jats:sec>","DOI":"10.1002\/dmrr.3645","type":"journal-article","created":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T02:41:34Z","timestamp":1683081694000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["Classification of foot ulcers in people with diabetes: A\u00a0systematic review"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4586-2910","authenticated-orcid":false,"given":"Matilde","family":"Monteiro\u2010Soares","sequence":"first","affiliation":[{"name":"Portuguese Red Cross School of Health \u2013 Lisbon  Lisbon Portugal"},{"name":"MEDCIDS \u2013 Departamento de Medicina da Comunidade Informa\u00e7\u00e3o e Decis\u00e3o em Sa\u00fade Faculty of Medicine of the University of Porto  Porto Portugal"},{"name":"RISE@CINTESIS Faculty of Medicine Oporto University  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma J.","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Fiona Stanley Hospital  Murdoch Western Australia Australia"},{"name":"University of Western Australia Medical School Fiona Stanley Hospital  Murdoch Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Russell","sequence":"additional","affiliation":[{"name":"Leeds Institute of Clinical Trials Research University of Leeds  Leeds UK"},{"name":"Leeds Vascular Institute Leeds Teaching Hospitals NHS Trust  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gulapar","family":"Srisawasdi","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Sirindhorn School of Prosthetics Orthotics  Bangkok Thailand"},{"name":"Faculty of Medicine Siriraj Hospital Mahidol University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3695-192X","authenticated-orcid":false,"given":"Edward J.","family":"Boyko","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Washington  Seattle Washington USA"},{"name":"Veterans Affairs Puget Sound Health Care System  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph L.","family":"Mills","sequence":"additional","affiliation":[{"name":"Michael E. 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