Assessment of foot deformities in patients with type 2 diabetes mellitus


  • Ritesh A. Pandey Department of Orthopaedics, All India Institute of Medical Science, Patna, Bihar, India
  • Priyank Deepak Department of Orthopaedics, All India Institute of Medical Science, Patna, Bihar, India



Foot deformities, Diabetes mellitus, Peripheral neuropathy, Foot ulcer


Background: Affection of lower extremity in diabetic patients leads to development of several foot deformities. The knowledge so far about the particulars of foot deformity in diabetic population is limited. The current study aimed to assess prevalence of foot deformities in known diabetics and to compare it with non-diabetic population. It also aimed to know its association with various risk factors.

Methods: Foot was evaluated for presence of deformity in 80 patients with type 2 diabetes mellitus and was compared with the control group of 80 non-diabetic individuals. Type of deformity was noted and its prevalence was compared between the two groups. Statistical analysis was done to see the association of foot deformity with various risk factors.

Results: Prevalence of foot deformity was more in diabetics as compared to normal population (p<0.004). Forefoot was involved in majority of cases (84.93%) and nail deformities were most commonly seen (38.35%). Deformities were less common in patients who were aware of diabetic foot care measures (p<0.004) and were more common in presence of diabetic neuropathy, vasculopathy and uncontrolled glycaemic index.

Conclusions: All patients with diabetes should be screened for presence of neuropathy as this is the most common factor for development of a foot deformity and hence a foot ulcer. Other helpful screening measures include assessment for peripheral vascular disease and monitoring of glycaemic index (HbA1c). Patients should be educated about the diabetic foot care measures to avoid potential complications.



Joshi SR, Parikh RM. India-diabetes capital of the world: now heading towards hypertension. J Assoc Physicians India. 2007;55:323-4.

Kumar A, Goel MK, Jain RB, Khanna P, Chaudhary V. India towards diabetes control: Key issues. Australas Med J. 2013;6(10):524-31.

Naidoo P, Liu VJ, Mautone M, Bergin S. Lower limb complications of diabetes mellitus: a comprehensive review with clinicopathological insights from a dedicated high-risk diabetic foot multidisciplinary team. Brit J Radiol. 2015;88(1053):1053.

Gregg EW, Beckles GL, Williamson DF, Leveille SG, Langlois JA, Engelgau MM, et al. Diabetes and physical disability among older U.S. adults. Diabetes Care. 2000;23(9):1272-7.

Dolan NC, Liu K, Criqui MH, Greenland P, Guralnik JM, Chan C, et al. Peripheral artery disease, diabetes, and reduced lower extremity functioning. Diabetes Care. 2002;25(1):113-20.

Muller IS, Grauw WJ, van Gerwen WH, Bartelink ML, van Den Hoogen HJ, Rutten GE. Foot ulceration and lower limb amputation in type 2 diabetic patients in Dutch primary health care. Diabetes Care. 2002;25(3):570-4.

Veves A, Murray HJ, Young MJ, Boulton AJ. The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. Diabetologia. 1992;35(7):660-3.

Reiber GE, Vileikyte L, Boyko EJ, Aguila MD, Smith DG, Lavery LA, et al. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care. 1999;22(1):157-62.

Fernando ME, Crowther RG, Cunningham M, Lazzarini AP, Sangla KS, Golledge J. Lower limb biomechanical characteristics of patients with neuropathic diabetic foot ulcers: the diabetes foot ulcer study protocol. BMC Endocr Disord. 2015;15:59.

Chantal N, DaSilva M, Carvalho LC, Lunes DH. Foot reflexology in feet impairment of people with type 2 diabetes mellitus: randomized trial. Rev Lat Am Enfermagem. 2015;23(4):603-10.

Runfeld GC. Diabetic foot ulcers. Etiology, treatment, and prevention. Adv Intern Med. 1992;37:103-32.

Caselli A, Pham H, Giurini J, Armstrong D, Veves A. The forefoot-to-rearfoot plantar pressure ratio is increased in severe diabetic neuropathy and can predict foot ulceration. Diabetes Care. 2002;25(6):1066-71.

Moss SE, Klein R, Klein BK. The 14-year incidence of lower-extremity amputations in a diabetic population: the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Diabetes Care. 1999;22:951-9.

Li X, Xiao T, Wang Y, Gu H, Liu Z, Jiang Y, et al. Incidence, risk factors for amputation among patients with diabetic foot ulcer in a Chinese tertiary hospital. Diabetes Res Clin Pract. 2011;93:26-30.

Armstrong DG, Lavery LA, Vela SA, Quebedeaux TL, Fleischli JG. Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration. Arch Intern Med. 1998;158:289-92.

Saltzman CL, Rashid R, Fellner C, Fitzpatric D, Klapach A. 4.5 gm monofilament sensation beneath both first metatarsal heads indicates protective foot sensation in diabetic patients. J Bone Joint Surg. 2004;86:717-23.

Catherine LM, Barbara HW, Rodica PB, Patricia AC, Sarah C, James WA, et al. Vibration perception threshold as a measure of distal symmetrical peripheral neuropathy in type 1 diabetes. Diabetes Care. 2010;33(12):2635-41.

Young MJ, Every N, Boulton AJ. A comparison of the neurothesiometer and biothesiometer for measuring vibration perception in diabetic patients. Diabetes Res Clin Pract. 1993;20(2):129-31.

Tantisiriwat N, Janchai S. Common foot problems in diabetic foot clinic. J Med Assoc Thai. 2008;91(7):1097-101.

Deshpande AD, Hayes MH, Schootman M. Epidemiology of diabetes and diabetes-related complications. Phys Ther. 2008;88(11):1254-64.

Cook JJ, Simonson DC. Epidemiology and health care cost of diabetic foot problems. The Diabetic Foot: Medical and Surgical Management. Contempor Diabet. 2012;17:779-91.

Ogbera AO, Adedokun A, Fasanmade OA, Ohwovoriole AE, Ajani M. The foot at risk in Nigerians with diabetes mellitus-the Nigerian scenario. Int J Endocrinol Metab. 2005;4:165-73.

Mansour AA, Imran HJ. Foot abnormalities in diabetics: prevalence and predictors in Barsah, Iraq. Pak J Med Sci. 2006;22(3):229-33.

Ababneh A, Bakri FG, Khader Y, Lazzarini P, Ajlouni K. Prevalence and associates of foot deformities among patients with diabetes in Jordan. Curr Diabetes Rev. 2020;16(5):471-82.

Mekonnen BE, Wirtu AT, Kebede MA, Tilahun AG, Degaga TK. Diabetics-related foot deformity: prevalence, risk factors, knowledge and practice. Trends Anat Physiol. 2021;4:10.

Barth R, Campbell LV, Allen S, Jupp JJ, Chisholm DJ. Intensive education improves knowledge, compliance, and foot problems in type 2 diabetes. Diabet Med. 1991;8:111-7.

Litzelman DK, Slemenda CW. Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus. A randomized, controlled trial. Ann Intern Med. 1993;119:36-41.

Pieber TR, Holler A, Siebenhofer A, Brunner GA, Semlitsch B, Schattenberg S, et al. Evaluation of a structured teaching and treatment programme for type 2 diabetes in general practice in a rural area of Austria. Diabet Med.1995;12(4):349-54.

Davies M, Brophy S, Williams R, Taylor A. The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care. 2006;29(7):1518-22.

Bansal V, Kalita J, Misra UK. Diabetic neuropathy. Postgrad Med J. 2006;82(964):95-100.

Bansal D, Gudala K, Muthyala H, Esam H, Nayakallu R, Bhansali A. Prevalence and risk factors of development of peripheral diabetic neuropathy in type 2 diabetes mellitus in a tertiary care setting. J Diabetes Investig. 2014;5(6):714-21.

Boyko EJ, Nelson KM, Ahroni JH, Heagerty PJ, Cohen V. Prediction of diabetic foot ulcer occurrence using commonly available clinical information. Seattle Diabet Foot Stud. 2006;29:1202-07.

Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217-28.

Holewski JJ, Moss KM, Stress RM, Graf PM, Grunfeld C. Prevalence of foot pathology and lower extremity complications in a diabetic outpatient clinic. J Rehabil Res Dev.1989;26:35-44.

Peters EJ, Lavery LA. Effectiveness of the diabetic foot risk classification system of the International Working Group on the Diabetic Foot. Diabetes Care. 2001;24(8):1442-7.

Perkins BA, Douglas AG, Bril V. Glycemic control is related to the morphological severity of diabetic sensorimotor polyneuropathy. Diabetes Care. 2001;24:748-52.






Original Research Articles