title: Prevalence of foot disease and risk factors in general inpatient populations: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To systematically review studies reporting the prevalence in general adult inpatient populations of foot disease disorders (foot wounds, foot infections, collective 'foot disease') and risk factors (peripheral arterial disease (PAD), peripheral neuropathy (PN), foot deformity).
  
  
  METHODS
  A systematic review of studies published between 1980 and 2013 was undertaken using electronic databases (MEDLINE, EMBASE and CINAHL). Keywords and synonyms relating to prevalence, inpatients, foot disease disorders and risk factors were used. Studies reporting foot disease or risk factor prevalence data in general inpatient populations were included. Included study's reference lists and citations were searched and experts consulted to identify additional relevant studies. 2 authors, blinded to each other, assessed the methodological quality of included studies. Applicable data were extracted by 1 author and checked by a second author. Prevalence proportions and SEs were calculated for all included studies. Pooled prevalence estimates were calculated using random-effects models where 3 eligible studies were available.
  
  
  RESULTS
  Of the 4972 studies initially identified, 78 studies reporting 84 different cohorts (total 60 231 517 participants) were included. Foot disease prevalence included: foot wounds 0.01-13.5% (70 cohorts), foot infections 0.05-6.4% (7 cohorts), collective foot disease 0.2-11.9% (12 cohorts). Risk factor prevalence included: PAD 0.01-36.0% (10 cohorts), PN 0.003-2.8% (6 cohorts), foot deformity was not reported. Pooled prevalence estimates were only able to be calculated for pressure ulcer-related foot wounds 4.6% (95% CI 3.7% to 5.4%)), diabetes-related foot wounds 2.4% (1.5% to 3.4%), diabetes-related foot infections 3.4% (0.2% to 6.5%), diabetes-related foot disease 4.7% (0.3% to 9.2%). Heterogeneity was high in all pooled estimates (I(2)=94.2-97.8%, p<0.001).
  
  
  CONCLUSIONS
  This review found high heterogeneity, yet suggests foot disease was present in 1 in every 20 inpatients and a major risk factor in 1 in 3 inpatients. These findings are likely an underestimate and more robust studies are required to provide more precise estimates.
authors.affiliation: School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia Wound Management Innovation Cooperative Research Centre, Brisbane, Queensland, Australia.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Lazzarini
authors.affiliation: School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Sheree E
authors.initials: SE
authors.lastname: Hurn
authors.affiliation: Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia Podiatry Service, Kirwan Community Health Campus, Townsville Hospital and Health Service, Townsville, Queensland, Australia.
authors.forename: Malindu E
authors.initials: ME
authors.lastname: Fernando
authors.affiliation: Department of Podiatry, West Moreton Hospital & Health Service, Ipswich, Queensland, Australia.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Jen
authors.affiliation: Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia Centre for Musculoskeletal Research, Griffith Health Institute, Griffith University, Gold Coast, Australia.
authors.forename: Suzanne S
authors.initials: SS
authors.lastname: Kuys
authors.affiliation: School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Maarten C
authors.initials: MC
authors.lastname: Kamp
authors.affiliation: School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Lloyd F
authors.initials: LF
authors.lastname: Reed
mesh_terms: D017719:Diabetic Foot / Q000453:epidemiology; D005534:Foot Diseases / Q000453:epidemiology*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D003668:Pressure Ulcer / Q000453:epidemiology; D012307:Risk Factors
keywords: EPIDEMIOLOGY; WOUND MANAGEMENT