Are Foot Abnormalities More Common in Adults with Diabetes? A Cross-Sectional Study in Basrah, Iraq
Abbas Ali Mansour, MD; Samir Ghani Dahyak, MD
Fall 2008 - Volume 12 Number 4
Background: Altered foot biomechanics, limited joint mobility, and bony deformities with neuropathy, peripheral vascular disease, and infection have been associated with an increased risk of ulceration and amputation among patients with diabetes. The aim of our study was to estimate prevalence of foot abnormalities among Iraqis with diabetes and to see if they are more common than in a control population.
Methods: We structured the study as a comparative outpatient clinic study. The study population consisted of 100 patients with type 2 diabetes and 100 patients without diabetes as the control group. The study was conducted between January 2006 and August 2007. The patients and study control subjects were selected from the outpatient clinic at Al-Faiha Hospital in Basrah, southern Iraq. All were adults of at least 40 years of age.
Results: There were no differences between the two groups regarding sex, age, weight, qualifications, smoking status, marital status, or residency, but patients with diabetes had a higher body mass index and a higher socioeconomic status. No differences were found in the type of footwear worn or in occupation. Foot abnormalities associated with diabetes were prominent metatarsal heads, hammertoe, high medial arch, wasting, joint stiffness, amputation, fissures, nail changes, ulcer, and dermopathy on univariate analysis. With a multivariable model using logistic regression, only wasting (odds ratio [OR], 0.21; 95% confidence interval [CI], 2.16–11.33; p = 0.0002), ulcer (OR, 0.08; 95% CI, 1.12–134.59; p = 0.03), and dryness (OR, 0.11; 95% CI; 1.19–7.32; p = 0.01) remained significantly associated with diabetes.
Conclusion: We checked for 17 foot abnormalities associated with diabetes and found that 13—prominent metatarsal head, high medial arch, hammertoe, wasting, joint stiffness, amputation, fissures, nail changes, ulcers, blisters, dryness, sclerosis, and dermopathy—were statistically more frequent in study participants with diabetes than in control study subjects without diabetes. In a logistic regression model, only wasting, ulcer, and dryness remained strongly associated with diabetes. A larger study is needed to see the relationship of these abnormalities with footwear worn, duration of wearing footwear, occupation, duration of diabetes, and insulin use.