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.
