PRACTICAL CRITERIA FOR SCREENING PATIENTS AT HIGH-RISK FOR DIABETIC FOOT ULCERATION

Background: A comprehensive understanding of clinical risk factors for developing foot ulcerations would help clinicians to categorize patie nts by their risk status and schedule intervention resources according ly to prevent amputation. Objective: To evaluate risk factors for foot ulcerations among persons with diabetes mellitus. Method: We enrolled 225 age-matched patients, 46.7% male, with a ratio of approximately 1 :2 cases: controls (76 case-patients and 149 control subjects). Case-p atients were defined as subjects who met the enrollment criteria and w ho had an existing foot ulceration or a recent history of a foot ulcer ation. Control subjects were defined as subjects with no history of fo ot ulceration. A stepwise logistic regression model was used for analy sis. Results: An elevated plantar pressure (>65 N/cm(2)), history of a mputation, lengthy duration of diabetes (>10 years), foot deformities (hallux rigidus or hammer toes), male sex, poor diabetes control (glyc osylated hemoglobin >9%), 1 or more subjective symptoms of neuropathy, and an elevated vibration perception threshold (>25 V) were significa ntly associated with foot ulceration. In addition, 59 patients (78%) w ith ulceration had a rigid deformity directly associated with the site of ulceration. No significant associations were noted between vascula r disease, level of formal education, nephropathy, retinopathy, impair ed vision, or obesity and foot ulceration on multivariate analysis. Co nclusions: Neuropathy, foot deformity, high plantar pressures, and a h istory of amputation are significantly associated with the presence of foot ulceration. Although vascular and renal disease may result in de layed wound healing and subsequent amputation, they are not significan t risk factors for the development of diabetic foot ulceration.