In this longitudinal study of 1666 persons with diabetes, there was an observed trend toward an increased risk for amputation (chi(2) test for trend, 108.0; P<.001), higher-level amputation (chi(2) test for trend, 113.3; P<.001), and lower extremity-related hospitalization (chi(2) test for trend, 118.6; P<.001) with increasing infection severity. The Infectious Diseases Society of America's foot infection classification system may be a useful tool for grading foot infections.

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 Ϯ 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 Ͻ 0.001). When risk category 2 (neuropathy and deformity and/or PAOD) was stratified by PAOD, there were more complications in PAOD patients (P Ͻ 0.01). When risk group 3 patients (ulceration or amputation history) were separately stratified, there were more complications in subjects with previous amputation (P Ͻ 0.01).CONCLUSIONS -We propose a new risk classification that predicts future foot complications better than that currently used by the IWGDF. Diabetes Care 31:154-156, 2008

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