Predictors of Diabetic Foot Reulceration beneath the Hallux

J Diabetes Res. 2019 Jan 8:2019:9038171. doi: 10.1155/2019/9038171. eCollection 2019.


Aims: 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 to assess the risk factors associated with hallux reulceration. Sixty patients with diabetic neuropathy and a history of previous ulcer were consecutively included. Sociodemographic factors and comorbidities plus the biomechanical and radiographic factors were obtained. Follow-up on participants was conducted every month, and they wore offloading therapeutic footwear and custom-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: 9 patients (31%) in the hallux and 20 (69%) in other locations. Functional hallux limitus (p = 0.005, 95% CI (2.097-73.128), HR 12.384) and increased body mass index (p = 0.044, 95% CI (1.003-1.272), HR 1.129) were associated with the hallux ulceration-free survival time in the multivariate Cox model.

Conclusions: Obesity and the presence of functional hallux limitus increase the probability of developing hallux reulceration in patients with diabetic neuropathy and a history of ulcers.

MeSH terms

  • Aged
  • Body Mass Index
  • Diabetic Foot / diagnosis*
  • Diabetic Foot / pathology
  • Female
  • Hallux / pathology*
  • Humans
  • Male
  • Middle Aged
  • Recurrence
  • Risk Factors
  • Shoes