Skin Alterations of the Foot in Patients with Diabetes

Structural Alterations and Deformities

Deformities such as hammer toes, claw toes, hallux valgus, and prominent metatarsal heads are structural abnormalities that increase plantar pressure and the risk of ulceration, according to the International Diabetes Federation 1, 2, 3, 4
Limited joint mobility contributes to the development of abnormal pressure points, as recommended by the American Diabetes Association 5
Residuals from previous surgeries or amputations alter the biomechanics of the foot, as stated by the European Association for the Study of Diabetes 1, 2, 3, 4

Excessive calluses and callus formations indicate areas of increased pressure that require immediate treatment, as suggested by the American College of Foot and Ankle Surgeons 6, 5
Pre-ulcerative signs on toes with deformities should be identified early, according to the International Working Group on the Diabetic Foot 3

Plantar ulcers of the forefoot or midfoot are typically of neuropathic origin, resulting from the loss of protective sensation combined with repetitive mechanical trauma, as stated by the American Diabetes Association 6, 7
The annual incidence is approximately 2%, with recurrence rates of 30-40% in the first year and 65% at three years, according to the International Diabetes Federation 1, 3, 4, 7
78% of ulcers have peripheral neuropathy as a causal component, and more than 63% present with the triad of peripheral sensory neuropathy, minor trauma, and foot deformity, as recommended by the American College of Foot and Ankle Surgeons 6

Signs of peripheral arterial disease include alterations in circulation that affect skin integrity, as stated by the European Society of Cardiology 1, 2, 3, 4
Patients with ankle pressure <50 mmHg or ankle-brachial index <0.5 have a high risk of severe skin complications, according to the American Heart Association 7

Poor glucose control accelerates the development of skin complications, as recommended by the American Diabetes Association 6, 8
Loss of protective sensation (inability to feel light pressure with a 10g monofilament) is the most important risk factor, according to the International Diabetes Federation 1, 2, 6, 3, 4, 8
Smoking is a significant modifiable risk factor, as stated by the American Heart Association 6, 8
Retinopathy and nephropathy are associated with a higher risk of foot skin alterations, according to the American Diabetes Association 6, 8

All diabetic patients require a complete annual foot examination that includes evaluation of skin integrity, 10g monofilament testing, pulse examination, and evaluation of deformities, as recommended by the American Diabetes Association 6, 8
High-risk patients need evaluation every 1-3 months, according to the International Working Group on the Diabetic Foot 6, 7, 8