Common foot examination features of 247 Iranian patients with diabetes

Iran is a Middle Eastern country with a 70 million population. There are 3 million Iranians with diabetes mellitus (DM) and there is a high incidence of non traumatic amputation in this population. Amputation is often preceded by foot deformity or ulceration. We evaluated the routine foot examination of persons with diabetes (PWD) attending an outpatient Diabetic Clinic to identify the clinical characteristics that might be early warning signs of individuals at a high risk of developing a foot ulcer or having a subsequent non traumatic amputation.

A prospective, descriptive, clinic-based study was conducted on 247 patients with diabetes mellitus in 2005. The objectives of the study were to define the abnormal features of the foot examination in PWD which could be risk factors for ulceration or amputation.

The mean age of patients with diabetes was 52 +/- 12. The prevalence of callus in the enrolled patients was 12% and heel fissures were noted in 50%. There was a significant relationship between callus formation and the absence of tibialis posterior pulse (odds ratio 5), the presence of the hammer toe deformity (odds ratio 4), and foot ulceration (odds ratio 3). The prevalence of foot ulcers in PWD was 4%.

A diabetic screening program identifying callus formation, absent pulses, and hammer toe are important early signs of individuals at an increased risk for foot ulcers. This program will facilitate early treatment to decrease the loss of limbs.