The at-risk foot concerns not only patients with diabetes mellitus

Abstract

Background: The prevalence of the at-risk foot in patients with diabetes is high and is increasing with age. The screening of the at-risk foot should be performed in all geriatric patients and on a regular basis.

Objective: To estimate the prevalence of at-risk foot in a geriatric population of patients and to identify associated principal risk factors in patients with diabetes, nondiabetic patients with neurological disorders and subjects without any known cause of sensory loss at the lower limb.

Methods: A longitudinal prospective study has been conducted in a university long-term care facility with mostly geriatric patients.Four hundred and twenty-six consecutive hospital admissions were recruited between October 2005 and September 2006.Lower limb neuropathy (LLN) was evaluated by the vibration perception threshold using a 128-Hz Rydel-Seiffer tuning fork. Peripheral vascular disease (PVD) was evaluated by the Doppler technique. Patients with LLN and/or PVD were considered to have at-risk foot.

Results: Of the 426 participants (median age 80 years, range 26-97), 110 (25.8%) had LLN, 82 (19.2%) had PVD and 92 (21.6%) had both LLN and PVD. Diagnosed diabetes mellitus was present in 96 (22.5%) patients and different neurological disorders having impact on foot sensitivity in 100 (23.5%) patients. The prevalence of the at-risk foot was similar in patients with diabetes (68.7%), in nondiabetic patients with chronic neurological medical conditions (66.0%), or in those without any evidence of diabetes or neurological disease (66.1%). Age was shown to be a predictive factor for the presence of LLN (OR 1.02, 95% CI 1.01-1.04, p = 0.002).

Conclusion: The prevalence of the at-risk foot in geriatric patients is high, independently of the presence of diabetes. The results suggest that both nondiabetic patients and patients with chronic neurological disorders should be screened for the presence of LLN and PVD as diabetic patients. This screening should be mandatory both in institutions and at home by the general practitioner(s).