title: Diabetic foot complications in a northern Canadian Aboriginal community.
abstract: BACKGROUND
  Limited access to basic foot care and protective footwear may contribute to diabetic foot complications. The purpose of this study was to determine the prevalence of foot complications, ongoing foot care, and footwear use in diabetic subjects in a remote northern Canadian Aboriginal community.
  
  
  METHODS
  This was a cross-sectional cohort study of 169 diabetic people, including interview, physical examination, and retrospective chart review.
  
  
  RESULTS
  The mean age of the 169 diabetic individuals in the study was 56 +/- 12 years and their duration of diabetes 10 +/- 7 years. There were 139 (82%) individuals who had 418 diabetic foot complications (average, 3.0 complications per subject with complications), including toenail pathology, foot and ankle deformities, calluses, impaired pulses, neuropathy, past or present ulcer, amputation, and Charcot arthropathy. Risk classification showed that 69 (41%) individuals were at risk for future ulceration. Fifty-five (33%) individuals had inadequate footwear for their foot risk category, and only 11 (17%) of 66 individuals in the higher risk categories (categories 2 and 3) had suitable footwear. In a 7-year period, only 0.7 screening foot examinations per diabetic subject per year were documented. However, during this period, foot problems accounted for 498 (18%) local emergency room visits, 359 (16%) hospitalization days, 109 (11%) nonemergency transfers, and 4 (6%) emergency transfers to a tertiary care hospital.
  
  
  CONCLUSIONS
  Foot and ankle complications of diabetes in this remote Aboriginal community were common and associated with substantial morbidity. Preventive diabetic foot screening examinations and footwear were inadequate. The results suggest that programs for prevention and early detection of complications are needed, including foot screening, provision of appropriate footwear, and foot care.
authors.affiliation: School of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Kristin S
authors.initials: KS
authors.lastname: Reid
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Martin
authors.forename: Frank
authors.initials: F
authors.lastname: Duerksen
authors.forename: Lindsay E
authors.initials: LE
authors.lastname: Nicolle
authors.forename: Mark
authors.initials: M
authors.lastname: Garrett
authors.forename: J Neil
authors.initials: JN
authors.lastname: Simonsen
authors.forename: Elly
authors.initials: E
authors.lastname: Trepman
authors.forename: John M
authors.initials: JM
authors.lastname: Embil
mesh_terms: D015331:Cohort Studies; D003430:Cross-Sectional Studies; D017719:Diabetic Foot / Q000208:ethnology / Q000473:pathology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007198:Indians, North American; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012775:Shoes