The influence of deformity and limited joint mobility on foot ulceration in type 2 diabetes

Abstract

Aim: To investigate the influence of foot deformities on diabetes foot ulcer development. Methods: Two groups of n = 50 participants were recruited; Group A with current and/or history of foot ulceration, Group B matched for main confounding variables, without ulcers. A comprehensive clinical and biomechanical examination was performed to record foot deformities, together with foot joint range of motion. Results: 68% of ulcers in Group A were located in the toes, with the apex of the 2nd toe being the commonest site of ulceration (26%), whilst 32% of the ulcers were located under the 1st (20%) and 5th (12%) metatarsophalangeal joints. Group A exhibited significantly more foot deformities than Group B, including hammer, claw and mallet toe deformities, limitation in joint mobility at the joints, including the ankle, subtalar, midtarsal, first ray and first metatarsophalangeal joint. Prominent metatarsophalangeal joints were also more common in Group A (60 - 66%; p < 0.001). Conclusion: Toe deformities, which may often be considered as insignificant in clinical practice, are an important aspect that need to be managed well in patients living with diabetes mellitus in order to try to prevent the onset of ulceration. Methods to improve joint motion should also be advised to patients at risk.