title: Prevalence of equinus in diabetic versus nondiabetic patients.
abstract: BACKGROUND
  There are no conclusive data to support the contention that diabetic patients have an increased frequency of ankle equinus compared with their nondiabetic counterparts. Additionally, a presumed contributing cause of foot ulceration is ankle joint equinus. Therefore, we sought to determine whether persons with diabetes have a higher prevalence of ankle joint equinus than do nondiabetic persons.
  
  
  METHODS
  A prospective pilot survey of 102 outpatients (43 diabetic and 59 nondiabetic) was conducted. Demographic and historical data were obtained. Each patient underwent a standard lower-extremity examination, including the use of a biplane goniometer to measure ankle joint range of motion.
  
  
  RESULTS
  Equinus, defined as ankle dorsiflexion measured at 0° or less, was found in 24.5% of the overall population. In the diabetes cohort, 16 of 43 patients (37.2%) were affected compared with 9 of 59 nondiabetic participants (15.3%) (P = .011). There was a threefold risk of equinus in the diabetic population (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.28-8.44; P < .013). The equinus group had a history of ulceration in 52.0% compared with 20.8% of the nonequinus group (P = .003). Equinus, therefore, imparted a fourfold risk of ulceration (OR, 4.13; 95% CI, 1.58-10.77; P < .004). We also found a 2.8 times risk of equinus in patients with peripheral neuropathy (OR, 2.8; 95% CI, 1.11-7.09; P < .029).
  
  
  CONCLUSIONS
  Equinus may be more prevalent in diabetic patients than previously reported. Although we cannot prove causality, we found a significant association between equinus and ulceration.
authors.affiliation: Podiatry Department, Carl T. Hayden Veterans Affairs Medical Center, Phoenix, AZ, USA. Robert.Frykberg@med.va.gov
authors.forename: Robert G
authors.initials: RG
authors.lastname: Frykberg
authors.forename: Joel
authors.initials: J
authors.lastname: Bowen
authors.forename: Jared
authors.initials: J
authors.lastname: Hall
authors.forename: Arthur
authors.initials: A
authors.lastname: Tallis
authors.forename: Edward
authors.initials: E
authors.lastname: Tierney
authors.forename: Denise
authors.initials: D
authors.lastname: Freeman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D017719:Diabetic Foot / Q000453:epidemiology; D003929:Diabetic Neuropathies / Q000453:epidemiology; D004863:Equinus Deformity / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies