The importance of clinical biomechanical assessment of foot deformity and joint mobility in people living with type-2 diabetes within a primary care setting

Aims: The aim of the study was to assess foot morphology and document foot deformities and joint mobility in a cohort of subjects living with type-2 diabetes mellitus in Malta in a Primary Care setting. Methods: A retrospective observational study was conducted on 243 subjects who participated in a local pilot diabetes foot screening project. Assessments included hammer/claw toes, hallux valgus, hallux limitus, prominent metatarsal heads, bony prominences, Charcot deformity, plantar callus, foot type and ankle and hallux mobility. The clinical assessments used during this screening program were based on validated and previously published tools. Results: Upon clinical examination 38 of the sample was found to have developed some form of corns or callosities in their feet. Hallux valgus deformity was present in 49.4 of the sample, whilst 39 of the sample had hammer toes. Prominent metatarsal heads (24), other bony prominences (44) and limited joint mobility were also reported. Furthermore, 56 of the sample presented with unsuitable footwear and upon clinical biomechanical examination a further 28 of the sample required prescription orthosis. Conclusions/interpretation: A significant proportion of participants living with type-2 diabetes presented with foot deformities which are known to be predictive of foot ulceration in this high risk population. This research conducted in a primary care setting highlights the importance of increased vigilance coupled with strengthening of existing screening structures and introducing clinical guidelines with regards to biomechanical assessment of the feet in a primary care setting in order to reduce the incidence of diabetes foot complications. © 2012 Primary Care Diabetes Europe.