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Reevaluating the Way We Classify the Diabetic Foot

Restructuring the diabetic foot risk classification system of the International Working Group on the Diabetic Foot

¹ Department of Surgery, Texas A&M Health Science Center, Scott and White Hospital, Temple, Texas
² Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands
³ Private Practice, Aurora, Colorado

Address correspondence and reprint requests to Lawrence. A. Lavery, MD, Texas A&M Health Science Center, Scott & White Georgetown Clinic, 703 Highland Spring Ln., Georgetown, Texas 78628. E-mail: llavery{at}swmail.sw.org

OBJECTIVE—To separately evaluate peripheral arterial occlusive disease (PAOD) and foot ulcer and amputation history in a diabetic foot risk classification to predict foot complications.

RESEARCH DESIGN AND METHODS—We evaluated 1,666 diabetic patients for 27.2 ± 4.2 months. Patients underwent a detailed foot assessment and were followed at regular intervals. We used a modified version of the International Working Group on the Diabetic Foot's (IWGDF's) risk classification to assess complications during the follow-up period.

RESULTS—There were more ulcerations, infections, amputations, and hospitalizations as risk group increased (² for trend P < 0.001). When risk category 2 (neuropathy and deformity and/or PAOD) was stratified by PAOD, there were more complications in PAOD patients (P < 0.01). When risk group 3 patients (ulceration or amputation history) were separately stratified, there were more complications in subjects with previous amputation (P < 0.01).

CONCLUSIONS—We propose a new risk classification that predicts future foot complications better than that currently used by the IWGDF.

Abbreviations: PAOD, peripheral arterial occlusive disease • IWGDF, International Working Group on the Diabetic Foot

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