Prevalence and Associates of Foot Deformities among Patients with Diabetes in Jordan

Objectives: To determine the prevalence of, and factors associated with, people with foot deformities, among patients with diabetes in Jordan. Methods: A cross-sectional study was conducted on 1000 diabetic participants recruited from the National Center for Diabetes, Endocrinology, and Genetics in Jordan. Participants had their feet clinically examined to detect the following foot deformity outcomes: Hallux valgus, claw/hammer toe, prominent metatarsal heads, limited joint mobility, pes cavus, Charcot foot, and amputations. Sociodemographic and health variables were also collected from participants’ interviews, medical records, or clinical examination. Logistic regression was used to analyse associations between variables and each foot deformity outcome. Results: Of the 1000 diabetic patients: Hallux valgus was found in 17.4%, claw\hammer toe in 16%, prominent metatarsal head in 14.2%, limited joint mobility in 9.4%, pes cavus in 3.2%, Charcot foot in 2.1%, and amputations in 1.7%. Hallux valgus was associated with gender (p=0.012), age (p<0.01) and shoe choices (p=0.031); claw\hammer toe was associated with age (p=0.04), retinopathy (p<0.001), sensory and painful neuropathy (p<0.001); limited joint mobility was associated with age only (p=0.001); Charcot foot was associated with glycemic control (p=0.016), hypertension (p<0.000), sensory neuropathy (p<0.001), and painful neuropathy (p<0.001); and, amputations were associated with duration of diabetes (p<0.043), sensory neuropathy (p=0.001), and painful neuropathy (p=0.001). Conclusion: Prevalence of different foot deformities in Jordan variedbetween 1.7% - 17.4%. Sociodemographic factors such as age, gender and shoes choices or presence of diabetes-related microvascular complications (neuropathy and retinopathy) or hypertension were independently associated with foot deformities among the Jordanian diabetic population.

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Foot Biomechanics in Patients with Diabetes Mellitus

Journal of the American Podiatric Medical Association ◽

10.7547/1010208 ◽

2011 ◽

Vol 101 (3) ◽

pp. 208-214 ◽

Cited By ~ 24

Author(s):

José Luis Lázaro-Martínez ◽

Francisco Javier Aragón-Sánchez ◽

Juan Vicente Beneit-Montesinos ◽

Maximo A. González-Jurado ◽

Esther García Morales ◽

...

Keyword(s):

Diabetes Mellitus ◽

Diabetic Neuropathy ◽

Metatarsophalangeal Joint ◽

Foot Deformities ◽

Joint Mobility ◽

Limited Joint Mobility ◽

First Metatarsophalangeal Joint ◽

Foot Biomechanics ◽

Mobility Studies ◽

Patients With Diabetes

Background: We sought to identify the biomechanical characteristics of the feet of patients with diabetes mellitus and the interrelationship with diabetic neuropathy by determining the range of joint mobility and the presence and locations of calluses and foot deformities. Methods: This observational comparative study involved 281 patients with diabetes mellitus who underwent neurologic and vascular examinations. Joint mobility studies were performed, and deformities and hyperkeratosis locations were assessed. Results: No substantial differences were found between patients with and without neuropathy in joint mobility range. Neuropathy was seen as a risk factor only in the passive range of motion of the first metatarsophalangeal joint (mean ± SD: 57.2° ± 19.5° versus 50.3° ± 22.5°, P = .008). Mean ± SD ankle joint mobility values were similar in both groups (83.0° ± 5.2° versus 82.8° ± 9.3°, P = .826). Patients without neuropathy had a higher rate of foot deformities such as hallux abductus valgus and hammer toes. There was also a higher presence of calluses in patients without neuropathy (82.8% versus 72.6%; P = .039). Conclusions: Diabetic neuropathy was not related to limited joint mobility and the presence of calluses. Patients with neuropathy did not show a higher risk of any of the deformities examined. These findings suggest that the etiology of biomechanical alterations in diabetic people is complex and may involve several anatomically and pathologically predisposing factors. (J Am Podiatr Med Assoc 101(3): 208–214, 2011)

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Relationship of Limited Joint Mobility and Foot Deformities with Neurological Examination in Patients with Diabetes

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/s-0032-1329981 ◽

2013 ◽

Vol 121 (04) ◽

pp. 239-243 ◽

Cited By ~ 4

Author(s):

I. Sanz-Corbalán ◽

J. Lázaro-Martínez ◽

E. García-Morales ◽

J. Aragón-Sánchez ◽

D. Carabantes-Alarcón ◽

...

Keyword(s):

Neurological Examination ◽

Foot Deformities ◽

Joint Mobility ◽

Limited Joint Mobility ◽

Patients With Diabetes ◽

Relationship Of

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Limited joint mobility syndrome in patients with diabetes

International Journal of Clinical Practice ◽

10.1111/j.1742-1241.2012.02891.x ◽

2012 ◽

Vol 66 (4) ◽

pp. 332-333 ◽

Cited By ~ 2

Author(s):

E. Otto-Buczkowska ◽

P. Jarosz-Chobot

Keyword(s):

Joint Mobility ◽

Limited Joint Mobility ◽

Patients With Diabetes ◽

Limited Joint Mobility Syndrome

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Insensitivity, Limited Joint Mobility, and Plantar Ulcers in Patients with Diabetes Mellitus

Physical Therapy ◽

10.1093/ptj/69.6.453 ◽

1989 ◽

Vol 69 (6) ◽

pp. 453-459 ◽

Cited By ~ 139

Author(s):

Michael J Mueller ◽

Jay E Diamond ◽

Anthony Delitto ◽

David R Sinacore

Keyword(s):

Diabetes Mellitus ◽

Joint Mobility ◽

Limited Joint Mobility ◽

Patients With Diabetes ◽

Plantar Ulcers

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Prevalence of Radiographic Foot Abnormalities in Patients with Diabetes

Foot & Ankle International ◽

10.1177/107110079701800606 ◽

1997 ◽

Vol 18 (6) ◽

pp. 342-346 ◽

Cited By ~ 51

Author(s):

Douglas G. Smith ◽

Brett C. Barnes ◽

Andrew K. Sands ◽

Edward J. Boyko ◽

Jessie H. Ahroni

Keyword(s):

Hallux Valgus ◽

Arterial Calcification ◽

Foot Deformities ◽

Radiographic Evidence ◽

First Metatarsal ◽

Joint Dislocations ◽

Second Metatarsal ◽

Patients With Diabetes ◽

Metatarsophalangeal Joints ◽

Radiographic Changes

Clinicians are increasingly aware that mechanical aspects of foot deformities, such as Charcot changes, clawtoes, bunion deformities, or cavus or planus foot deformities, might have an impact on the occurrence, potential healing, and recurrence of foot ulcers. We report the prevalence of plain radiographic changes and attempt to rate the severity of those deformities in the feet of 456 diabetic veteran medicine clinic enrollees. All 456 radiographs were reviewed by orthopaedic surgeons to specifically identify Charcot changes, presence of arterial calcification, dislocation of the lesser toe metatarsophalangeal joints, hallux interphalangeal joint dislocation, and radiographic evidence of previous surgery. Radiographs of 428 patients were taken while weightbearing, and these were reviewed to quantify hallux valgus angles, intermetatarsal 1–2 angles, fifth metatarsalproximal phalangeal angles, second metatarsal lengths, lateral talocalcaneal and talar-first metatarsal angles, and claw toe deformities. The prevalence of Charcot changes was 1.4% (six subjects), and all had radiographic evidence of midfoot Charcot changes. Other deformities, such as clawtoes, hallux valgus, lesser toe joint dislocations, and alterations in arch height, are more common in veterans with diabetes.

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49. Limited joint mobility in patients with diabetes mellitus

The Netherlands Journal of Medicine ◽

10.1016/s0300-2977(97)87103-3 ◽

1997 ◽

Vol 50 (5) ◽

pp. A19

Author(s):

R ERDTSIECK ◽

M VANDERLAAN ◽

M JACOBS ◽

R WEBER ◽

J ELTE

Keyword(s):

Diabetes Mellitus ◽

Joint Mobility ◽

Limited Joint Mobility ◽

Patients With Diabetes

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Distribution of the Highest Plantar Pressure Regions in Patients with Diabetes and Its Association with Peripheral Neuropathy, Gender, Age, and BMI: One Centre Study

Journal of Diabetes Research ◽

10.1155/2019/7395769 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

Edyta Sutkowska ◽

Krzysztof Sutkowski ◽

Michał Sokołowski ◽

Edward Franek ◽

Szymon Dragan

Keyword(s):

Plantar Pressure ◽

Foot Ulcer ◽

Sensory Neuropathy ◽

Female Gender ◽

Foot Deformities ◽

Lateral Part ◽

Simple Relationship ◽

Semiquantitative Assessment ◽

Common Location ◽

Patients With Diabetes

The abnormal plantar pressure distribution and value play a key role in the formation of plantar calluses and diabetic foot ulcer. The prevalence of the highest pressure different distribution and its association with various factors among patients with diabetes is not well known. The study purpose was to evaluate the prevalence of different regions for the highest pressure on the sole and its association with selected factors among patients with diabetes. Medical records of nonulcer patients were retrospectively analysed. The relationship between pressure patterns on the sole obtained during a pedobarographic test as a semiquantitative assessment with colourful print analysis and neuropathy, gender, age, and BMI was searched. The most common location of the highest pressure was the central part of the forefoot. No association was found between the different highest pressure regions and age, sensory neuropathy, calluses, and foot deformities. The highest pressure on the lateral part of the foot and midfoot was observed more often in females and in patients with a BMI≥35. The prevalence of the highest pressure on the forefoot was more common in patients with a BMI<35. Conclusions. The most frequent regions of the highest pressure on the sole in patients with diabetes were the central part of the forefoot (2-3 metatarsal heads) with no simple relationship to the assessed variables other than BMI<35. Female gender and higher BMI seem to be responsible for shifting the place of the highest pressure to other places of the foot.

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Spectrum of musculoskeletal disorders in Nigerians with types 2 diabetes mellitus: prevalence and predictors

Reumatismo ◽

10.4081/reumatismo.2019.1232 ◽

2020 ◽

Vol 71 (4) ◽

pp. 209-217

Author(s):

H. Olaosebikan ◽

A. Azenabor ◽

R. Akintayo ◽

O. Adelowo ◽

A. Ogbera ◽

...

Keyword(s):

Diabetes Mellitus ◽

Musculoskeletal Disorders ◽

Adhesive Capsulitis ◽

Clinical Parameters ◽

Joint Mobility ◽

Case Definitions ◽

Limited Joint Mobility ◽

Factors Associated ◽

Rotator Cuff Tendinitis ◽

Patients With Diabetes

Musculoskeletal (MSK) conditions are more frequently found among patients with diabetes mellitus (DM) than in the non-diabetics. Despite several reports outside Africa, they have been under-studied among Africans. This study aimed to assess the overall prevalence and predictors of MSK conditions in Nigerian with types 2 diabetes mellitus (T2DM). A total of 268 adult with T2DM and 268 non-diabetic controls were recruited. All study subjects had their socio-demographics and clinical parameters obtained using interviewer-administered questionnaire. Musculoskeletal conditions among study subjects were classified using validated criteria and case definitions. Musculoskeletal disorders (MSKD) were significantly more frequent amongst subjects with DM (56% vs 22%, OR=4.5 p=0.001). Osteoarthritis (9.3% vs 4.1%, p=0.016), lumbosacral spondylosis (5.6% vs 2.2%, p=0.045), limited joint mobility (13.8% vs 5.6%, p-0.001), adhesive capsulitis (4.5% vs 1.5%, p-0.042) and rotator cuff tendinitis (3.7% vs 0.4%, p=0.006) were more frequent in DM subjects than in controls. Logistic regression showed that age (OR=2.1, CI=1.5-2.6) and waist circumference (OR=3.0, CI=2.6- 3.4) are independent predictors of MSKD among patients with diabetes. This study found higher prevalence of MSKD among diabetic subjects. It also identified certain factors associated with MSKD among patients with diabetes mellitus.

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LIMITED JOINT MOBILITY SYNDROME IN DIABETES MELLITUS

Rheumatology Science and Practice ◽

10.14412/1995-4484-2020-330-335 ◽

2020 ◽

Vol 58 (3) ◽

pp. 330-335

Author(s):

T. S. Panevin ◽

L. I. Alekseeva ◽

G. A. Melnichenko

Keyword(s):

Diabetes Mellitus ◽

Vascular Complications ◽

Pain Syndrome ◽

Pathological Process ◽

Late Complications ◽

Lower Limbs ◽

Joint Mobility ◽

Limited Joint Mobility ◽

Locomotor Apparatus ◽

Patients With Diabetes

Patients with diabetes mellitus (DM) often show changes in the locomotor apparatus (LMA), in particular cheiroarthropathy, a specific lesion of the connective tissue structures of the hand in the presence of persistent hyperglycemia, which leads to limited joint mobility (LJM) generally in the absence of pain syndrome. Some authors use the term «LJM syndrome» to describe LMA lesion in DM, since in the long course of the disease, the small and large joints of not only the upper, but also the lower limbs are involved in the pathological process. LJM is one of the little studied and poorly diagnosed conditions in comparison with traditional micro- and macro-vascular complications of DM, which, due to their direct correlation with life expectancy, receive more attention. The LJM syndrome is associated with other late complications of DM and can significantly impair functional activity, self-care, and quality of life. Damages to periarticular tissue and joints in DM are believed to be caused by the accumulation of glycation end products. A clinical examination plays a key role in the diagnosis of cheiroarthropathy.

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