Common Foot Problems in Diabetic Foot Clinic
Natthiya Tantisiriwat MD*, Siriporn Janchai MD**
Affiliation : * Rehabilitation Center,Thai Red Cross Society, Bangkok ** Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok
Objective : To study common foot problems presented in diabetic foot clinic.
Material and Method: A retrospectively review of out patient department records and diabetic foot evalua-
tion forms of patients who visited the diabetic foot clinic at King Chulalongkorn Memorial Hospital between
2004 and 2006.
Results : Of all diabetic patients, 70 men and 80 women with the average age of 63.8 years were included in
this study. About 32% of all reported cases had lower extremity amputation in which the toe was the most
common level. Foot problems were evaluated and categorized in four aspects, dermatological, neurological,
musculoskeletal, and vascular, which were 67.30%, 79.3%, 74.0%, and 39.3% respectively. More than half of
the patients had skin dryness, nail problem and callus formation. Fifty six percent had the abnormal plantar
pressure area, which was presented as callus. The great toe was the most common site of callus formation,
which was correlated with gait cycle. The current ulcer was 18.8%, which was presented mostly at heel and
great toe. Three-fourth of the patients (75.3%) had lost protective sensation, measured by the 5.07 monofilament
testing. The most common problem found in musculoskeletal system was limited motion of the joint (44.0%).
Claw toe or hammer toe were reported as 32.0% whereas the other deformities were bunnion (12.0%), charcot
joint (6.0%) and flat feet (5.3%). The authors classified patients based on category risk to further lower
extremity amputation into four groups. Forty-seven percent had highest risk for having further amputation
because they had lost protective sensation from monofilament testing, previous current ulcer, or history of
amputation. Only half of the patients had previous foot care education.
Conclusion : Multidisciplinary diabetic foot care including patient education (proper foot care and footwear),
early detection, effective management of foot problems, and scheduled follow-up must be emphasized to
prevent diabetes-related lower extremities amputation.
Keywords : Diabetic foot problems, Diabetic foot ulcer, Non-traumatic lower extremity amputation
