Pedal Vessel Calcification and Risk of Major Adverse Foot Events in the Diabetic Neuropathic, Nephropathic Foot

Abstract

Background: We aimed to determine the relative risk of pedal vessel calcification (PVC) on major adverse foot events (MAFEs) and chronic kidney disease (CKD) stage in patients with diabetes mellitus (DM) and peripheral neuropathy (PN).

Methods: We retrospectively reviewed electronic medical records of 152 patients with diagnoses of DM, PN, and CKD stages one to five who had at least one foot radiograph obtained. PVC was scored (from 0-4) based on foot anatomic location and radiology reported MAFEs, which includes foot fracture, Charcot neuroarthropathy, foot ulcer, osteomyelitis, or minor amputation. Risk ratios (RR) with 95% confidence intervals (95% CI) and Poisson regressions were performed assessing the risk of sustaining MAFEs with number of PVCs and stage of CKD.

Results: The risk of any MAFE increased as PVC score increased (RR = 1.23); the risk of any MAFE increased as CKD stage increased (RR = 1.35); and risk of any PVC increased as CKD stage increased (RR = 1.71).

Conclusions: Pedal vessel calcification on a foot radiograph increases the risk of any MAFE and increases with progressive stage of CKD. Pedal vessel calcification may serve as a gateway to prompt investigation, treatment, or referral for at-risk diabetic neuropathic, nephropathic patients.

Figure 1.

Pedal Vessel Calcification (PVC) Scoring System 0 to 4 and anatomic location (digital, metatarsal, ankle/hindfoot anterior, and ankle/hindfoot posterior). PVC = 0 if NO calcified vessels identified. PVC =1 if ANY anatomic location identified as calcified, PVC = 2 if ANY 2/4 anatomic regions show calcification, PVC = 3 if ANY 3/4 anatomic locations show calcification, and PVC = 4 if ALL anatomic locations show calcification. Anatomic region divider Posterior/Anterior dividing line.