title: Reevaluating the way we classify the diabetic foot: restructuring the diabetic foot risk classification system of the International Working Group on the Diabetic Foot.
abstract: 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.
  
  
  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 (chi(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.
authors.affiliation: Department of Surgery, Texas A&M Health Science Center, Scott and White Hospital, Temple, Texas, USA. llavery@swmail.sw.org
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Lavery
authors.forename: Edgar J G
authors.initials: EJ
authors.lastname: Peters
authors.forename: Jayme R
authors.initials: JR
authors.lastname: Williams
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Murdoch
authors.forename: Amanda
authors.initials: A
authors.lastname: Hudson
authors.forename: David C
authors.initials: DC
authors.lastname: Lavery
mesh_terms: D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001157:Arterial Occlusive Diseases / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000503:physiopathology; D017719:Diabetic Foot / Q000145:classification* / Q000453:epidemiology* / Q000601:surgery; D016523:Foot Ulcer / Q000453:epidemiology; D006801:Humans; D018570:Risk Assessment; D012307:Risk Factors