Predictors of Diabetic Foot Reulceration beneath the Hallux

Abstract

To evaluate the factors that predict reulceration beneath the hallux in people with a history of diabetic foot ulceration. Methods. A prospective study conducted between January 2012 and December 2014 was performed in a diabetic foot unit toassess the risk factors associated with hallux reulceration. Sixty patients with diabetic neuropathy and a history of previous ulcerwere consecutively included. Sociodemographic factors and comorbidities plus the biomechanical and radiographic factors wereobtained. Follow-up on participants was conducted every month, and they wore offloading therapeutic footwear andcustom-made insoles. Hallux reulceration during the follow-up period was assessed as the main outcome measure in the study.Results. Patients were followed up during 29 (14.2-64.4) months. Twenty-nine patients (52%) developed a new ulceration: 9patients (31%) in the hallux and 20 (69%) in other locations. Functional hallux limitus (p = 0 005, 95% CI (2.097–73.128), HR12.384) and increased body mass index (p = 0 044, 95% CI (1.003-1.272), HR 1.129) were associated with the halluxulceration-free survival time in the multivariate Cox model. Conclusions. Obesity and the presence of functional hallux limitusincrease the probability of developing hallux reulceration in patients with diabetic neuropathy and a history of ulcers.