The following increase the risk of major complications in the diabetic foot:
- Previous ulceration
- Neuropathy (loss of pressure sensation to 10g neurofilament)
- Duration of diabetes
- Poor metabolic control
- Poor foot care
- Ill-fitting shoes
- Deformity
- Tight Achilles tendon
The International Working Group on the Diabetic Foot produced a risk stratification, which was studied in a prospective cohort of 225 patients followed for 3 years (Peters et al 2001).
Group |
Criteria |
Ulceration rate (%) |
Amputation rate (%) |
0 |
no neuropathy |
5 |
0 |
1 |
neuropathy, no deformity or vascular disease |
14 |
0 |
2 |
neuropathy and deformity or vascular disease |
19 |
3 |
3 |
previous ulcer or amputation |
55 |
21 |
Recently this has been modified in the light of further work on outcomes (Lavery 2008), reflecting the independently higher risk in patients with vascular disease:
- group 0 - no neuropathy or vascular disease
- group 1 - neuropathy, no vascular disease or deformity
- group 2A - neuropathy and deformity, no vascular disease
- group 2B - vascular disease
- group 3A - previous ulcer
- group 3B - previous amputation