Re-evaluating How We Classify the Diabetic Foot: Restructuring the International Working Group's Diabetic Foot Risk Classification
- Lawrence A. Lavery, MD (llavery{at}swmail.sw.org)1,
- Edgar. J. G. Peters, MD2,
- Jayme R. Williams, MD1,
- Douglas P. Murdoch, MD1,
- Amanda Hudson, MD1 and
- David C. Lavery, MD3
- 1 Surgery Texas A&M Health Science Center, Scott and White Hospital, Temple, TX 301 University Blvd, Round Rock, Texas
- 2 Leiden University Medical Center, Infectious Diseases and Internal Medicine. Leiden, The Netherlands
- 3 Private Practice Aurora, Colorado
Abstract
Aims: To separately evaluate peripheral arterial occlusive disease (PAOD) and foot ulcer and amputation history in a diabetic foot risk classification to predict foot complications.
Methods: We evaluated 1,666 diabetic patients for of 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) Risk Classification to assess complications during the follow-up period.
Results: There were more ulcerations, infections, amputations and hospitalizations as risk group increased ( Χ2 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).
Conclusion: We propose a new risk classification that predicts future foot complications better than the IWGDF.
Footnotes
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- Received July 7, 2007.
- Accepted October 5, 2007.
- Copyright © American Diabetes Association
