title: Forefoot ulcer risk is associated with foot type in patients with diabetes and neuropathy.
abstract: OBJECTIVE
  To stratify the ulceration risk according to the foot morphology in people with diabetes and a history of forefoot neuropathic ulceration.
  
  
  METHODS
  A cross-sectional study was performed on 139 neuropathic individuals with diabetes and previous forefoot ulcers between January 2012 and February 2014. Foot position of the participants was evaluated by using the foot-posture index. A multivariate analysis adjusted for confounding variables was performed with the ulceration risk factors that were found in the univariate analysis.
  
  
  RESULTS
  Two hundred and fifty-eight feet were analysed, 104 (40.3%) feet had a history of ulceration on the forefoot and 154 (59.7%) feet had no previous ulceration. Two positive tests of neuropathy (p<0.001; CI[1.961-6.249] OR 3.500), presence of deformities (p=0.043; CI[1.020-3.599] OR 1.916) and foot type (p=0.039) showed an association with ulceration risk in multivariate analyses. Pronated feet showed a higher risk of ulceration than supinated feet (p=0.011; CI[1.253-5.708] OR 2.675), while significant differences between neutral and supinated feet were not found (p=0.221; CI[0.719-2.753] OR 1.476).
  
  
  CONCLUSIONS
  A pronated foot has a higher risk of ulceration on the forefoot in neuropathic people with deformities and diabetes mellitus. Foot type should be evaluated in people at risk of ulceration.
authors.affiliation: Unidad de Pie Diabético, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain. Electronic address: rauljmolines@hotmail.com.
authors.forename: R J
authors.initials: RJ
authors.lastname: Molines-Barroso
authors.affiliation: Unidad de Pie Diabético, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Lázaro-Martínez
authors.affiliation: Unidad de Pie Diabético, Hospital La Paloma, Las Palmas de Gran Canaria, Spain.
authors.forename: F J
authors.initials: FJ
authors.lastname: Aragón-Sánchez
authors.affiliation: Unidad de Pie Diabético, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
authors.forename: F J
authors.initials: FJ
authors.lastname: Álvaro-Afonso
authors.affiliation: Unidad de Pie Diabético, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: García-Morales
authors.affiliation: Unidad de Pie Diabético, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
authors.forename: Y
authors.initials: Y
authors.lastname: García-Álvarez
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D017719:Diabetic Foot / Q000150:complications* / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000150:complications*; D005260:Female; D005530:Foot Deformities / Q000150:complications* / Q000503:physiopathology; D016523:Foot Ulcer / Q000209:etiology*; D006801:Humans; D008297:Male; D011187:Posture; D011403:Pronation / Q000502:physiology*; D012307:Risk Factors
keywords: Diabetic foot; Foot-posture index; Neuropathic ulcer