Reevaluating the way we classify the diabetic foot: Restructuring the diabetic foot risk classification system of the International Working Group on the Diabetic Foot

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 (X-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.