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The evidence to justify classifications of foot risk is derived from a number of large cross-sectional and prospective studies, and is very strong: it is possible to identify clinical features of the individual patient that are linked to the relative risk of future ulceration. The presence of peripheral arterial disease, neuropathy or deformity will increase the risk modestly, while any combination of these will increase it more and the risk is highest in those with a history of previous foot disease or surgery. If foot risk classification is linked to the increased adoption of preventive strategies of proven effectiveness, the incidence of new foot disease will fall. Foot risk classification should therefore become a routine part of diabetes care.

Stratification of foot risk predicts the incidence of new foot disease, but do we yet know that the adoption of routine screening reduces it?