Relationship between foot type, foot deformity, and ulcer occurrence in the high-risk diabetic foot

• Published in: Journal of rehabilitation research and development 2005-09, Vol.42 (5), p.665-672
• Main Authors: Ledoux, William R, Shofer, Jane B, Smith, Douglas G, Sullivan, Katrina, Hayes, Shane G, Assal, Mathieu, Reiber, Gayle E
• Format: Article
• Language: English
• Subjects: Age Distribution; Aged; Aged, 80 and over; Cohort Studies; Comorbidity; Confidence intervals; Diabetes; Diabetic Foot - diagnosis; Diabetic Foot - epidemiology; Feet; Female; Fingers & toes; Follow-Up Studies; Foot Deformities, Acquired - diagnosis; Foot Deformities, Acquired - epidemiology; Foot Deformities, Congenital - diagnosis; Foot Deformities, Congenital - epidemiology; Foot diseases; Hallux Limitus - diagnosis; Hallux Limitus - epidemiology; Hammer Toe Syndrome - diagnosis; Hammer Toe Syndrome - epidemiology; Health services; Humans; Incidence; Kidney diseases; Male; Middle Aged; Odds Ratio; Patients; Probability; R&D; Research & development; Risk Assessment; Severity of Illness Index; Sex Distribution; Shoes & boots; Studies; Terminal illnesses; Ulcers
• ISSN: 0748-7711; 1938-1352
• DOI: 10.1682/JRRD.2004.11.0144

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.