International Working Group on the Diabetic Foot Risk Classification System1 with Associated Interventions

Risk for
Ulceration or
Risk Category Criteria Interventions Amputation in
the Next 3
Years2
 Diagnosis of diabetes  Education including advise on appropriate footwear
 Intact sensation  Possible shoe accommodations
0
 ABI >0.8mmHg or toe pressure  Annual assessment by a generalist physician:
5.1% risk of
>45mmHg o Neurovascular status, i.e. palpation of pedal pulses, 10g
Normal, no ulceration
neuropathy  No hx of ulceration monofilament testing
 +/- Foot deformity o Dermal thermometry
o Inspection of feet and footwear
 Diagnosis of diabetes Same interventions as category 0 PLUS:
 Sensation absent  Consider prescriptive/accommodative footwear (this will require a pedorthic
1
 ABI >0.8mmHg or toe pressure or orthotist consult)
>45mmHg  Assessment of the person by a generalist physician every three to six months:
Loss of 14.3% risk of
protective  No hx of ulceration or Charcot o Neurovascular status, i.e. palpation of pedal pulses, 10g
ulceration
deformity monofilament testing
sensation
(LOPS)  No foot deformity o Dermal thermometry
o Inspection of feet and footwear
o Yearly dynamic plantar pressure updates
 Diagnosis of diabetes Same interventions as category 1 PLUS:
 Sensation absent  Consider pedorthic/orthotic consultation for possible custom-molded/extra-
 ABI >0.8mmHg or toe pressure depth shoes
>45mmHg  Consider need for prophylactic surgery if footwear is not able to 18.8% risk of
2a
 No hx of ulceration or Charcot accommodate foot deformity or relieve the focus of stress ulceration
deformity  Assessment of the person by a generalist physician every two-three months:
LOPS and
deformity  Foot deformity (focus of stress) o Neurovascular status, i.e. palpation of pedal pulses, 10g 3.1% risk of
monofilament testing amputation
o Dermal thermometry
o Inspection of feet and footwear
o Yearly dynamic plantar pressure updates
 2b  Diagnosis of diabetes Same interventions as category 2a PLUS: 18.8% risk of
 Sensation present/absent  Consider vascular consultation, possible revascularization ulceration
Peripheral  ABI <0.8mmHg or toe pressure  Assessment of the person by a specialist physician every two-three months
arterial <45mmHg 3.1% risk of
disease  May have an ulcer amputation
 Diagnosis of diabetes Same interventions as category 2a PLUS:
3a  Sensation absent  Assessment of the person by a specialist physician every one-two months 55.8% risk of
 ABI >0.8mmHg or toe pressure ulceration
Pervious >45mmHg
history of  Hx of ulceration and/or Charcot 20.9% risk of
ulceration deformity amputation
 Foot deformity (focus of stress)
 Diagnosis of diabetes Same interventions as category 3a PLUS:
 Sensation absent  Assessment of the person by a specialist physician every one-two months
3b 55.8% risk of
 ABI >0.8mmHg or toe pressure
ulceration
>45mmHg or ABI <0.8mmHg or NOTE: If there is a below knee amputation on one leg, there is a 50% likelihood of
Previous
toe pressure <45mmHg a similar amputation on the opposite extremity within five years3
history of 20.9% risk of
 Hx of ulceration and/or Charcot
amputation amputation
deformity
 Foot deformity (focus of stress)

References
1. Lavery L, Peters E, Williams J, et al. Reevaluating the way we classify the diabetic foot: Restructuring the diabetic foot risk classification
system of the International Working Group on the Diabetic Foot. Diabetes Care. 2008;31(1):154–156.
2. Peters EJ, Lavery LA. Effectiveness of the diabetic foot risk classification system of the International Working Group on the Diabetic Foot.
Diabetes Care. 2001:24(8):1442.
3. Izumi Y, Satterfield K, Kee S, et al. Risk of amputation in diabetic patients stratified by limb and level of amputation: A 10 year observation.
Diabetes Care. 2006:29(3):566-570.