The association between body mass index and foot disorders in diabetic patients

Fifteen percent of individuals with diabetes develop a foot ulcer during their lifetime, and 85% of lower extremity amputations are preceded by an ulcer with or without infection. This study was done to determine the association between morbid obesity and foot ulcer or infection in patients with diabetes.

During a 66-month period, 133 patients were admitted to a tertiary care university medical center with a diagnosis of foot ulcer or foot infection. There were 79 men and 54 women, with an average age of 62 +/- 12 years. During hospitalization, 52 patients had peripheral angiography, 18 patients had invasive cardiac procedures, and 13 patients had peripheral vascular surgery. Twenty-two patients were receiving chronic hemodialysis. Seventy-four patients had surgical debridement of an ulcer. Thirty-two patients had bony stabilization of a Charcot foot. Partial or Syme amputations were done on 36 patients, and 26 patients had a transtibial or more proximal level of amputation. Medical records data allowed calculation of body mass index (BMI) for 82 patients.

Mean BMI was 31 +/- 7 kg m2. Forty-six patients were obese (BMI > or = 30.0 kg m2), which is significantly higher than the national prevalence in adults (20.9%, p < 0.001). There was no correlation between BMI and length of hospitalization in the study patients.

In a tertiary care medical center with a high proportion of very ill patients, there appeared to be a strong correlation between diabetes-associated foot morbidity and morbid obesity.