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Logo for the Journal of Rehab R&D
Volume 42 Number 5, September/October 2005
Pages 665 — 672


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

William R. Ledoux, PhD;1-3* Jane B. Shofer, MS;1 Douglas G. Smith, MD;3 Katrina Sullivan, DPM;4 Shane G. Hayes, CPed;5 Mathieu Assal, MD;1,3 Gayle E. Reiber, PhD1,5-7

1Department of Veterans Affairs (VA), Rehabilitation Research and Development Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, VA Puget Sound Health Care System, Seattle, WA; Departments of 2Mechanical Engineering and 3Orthopaedics and Sports Medicine, University of Washington, Seattle, WA; 4Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA; 5Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle, WA; Departments of 6 Health
Services and 7Epidemiology, University of Washington, Seattle, WA
Abstract — 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.
Key words: diabetes mellitus, foot, foot deformity, foot type, hallux limitus, hallux valgus, hammer/claw toes, pes cavus, pes planus, ulcer.

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