Relationship between foot type, foot deformity, and ulcer occurrence in the high-risk diabetic foot.
We hypothesized an association between foot type, foot deformity, and foot ulceration and conducted an analysis of a well-characterized, high-risk diabetic population of 398 subjects. The average age was 62 years of age and 74% of the study population were males. Foot-type distributions were 19.5% pes cavus (high arch), 51.5% neutrally aligned (normal arch), and 29.0% pes planus (low arch). We quantified the presence of hallux valgus (23.9%), hammer/claw toes (46.7%), and hallux limitus (24.4%). A significant association was found between foot type and hallux valgus (p = 0.003); pes planus feet had the highest prevalence as compared with neutrally aligned feet (odds ratio [OR] = 2.43, p = 0.0006). Foot type was also significantly associated with fixed hammer/claw toes (p = 0.01); pes cavus feet had the highest prevalence as compared with neutrally aligned feet (OR = 3.89, p = 0.001). Foot type was also significantly associated with hallux limitus (p = 0.006) with pes planus feet having the highest prevalence as compared with neutrally aligned feet (OR = 2.19, p = 0.003). However, foot type was not significantly related to any ulcer outcome (p = 0.7). Fixed hammer/claw toes (OR = 3.91, p = 0.003) and hallux limitus (OR = 3.02, p = 0.006) were associated with increased risk of any ulcer occurrence. This study affirms that foot type and foot deformity are related and that foot deformities are associated with ulcer occurrence.
Department of Veterans Affairs (VA), Rehabilitation Research and Development Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, VA Puget Sound Health Care System, Seattle, WA 98108, USA. wrledoux @u.washington.edu
William R
WR
Ledoux
Jane B
JB
Shofer
Douglas G
DG
Smith
Katrina
K
Sullivan
Shane G
SG
Hayes
Mathieu
M
Assal
Gayle E
GE
Reiber
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D017719:Diabetic Foot / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005531:Foot Deformities, Acquired / Q000175:diagnosis / Q000453:epidemiology*; D005532:Foot Deformities, Congenital / Q000175:diagnosis / Q000453:epidemiology*; D020857:Hallux Limitus / Q000175:diagnosis / Q000453:epidemiology; D037801:Hammer Toe Syndrome / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution