We investigated the prevalence and factors independently associated with foot complications in a representative inpatient population (adults admitted for any reason with and without diabetes). We analysed data from the
Active foot disease (ulcers, infection, or ischaemia) is commonly precipitated by the foot complications of previous amputations, previous foot ulcers, peripheral arterial disease (PAD), peripheral neuropathy (PN), and foot deformity in both diabetes and nondiabetes populations [
Studies investigating foot complications in inpatient populations have predominantly focused within diabetes and geriatric inpatient populations [
This study was a secondary analysis of data collected from the
In brief, the
The explanatory variables for this study were grouped into the domains of participant demographics (age and sex), social determinants (socioeconomic status, geographical remoteness, education levels, country of birth, and indigenous status), medical condition history (diabetes, hypertension, dyslipidaemia, myocardial infarct, cerebrovascular accident, chronic kidney disease, smoking, cancer, arthritis, depression, and acute foot trauma), self-care ability (mobility impairment, vision impairment, and main footwear worn inside and outside the home), and past foot treatment in the year prior to hospitalisation (by podiatrist, general practitioner, specialist physician, surgeon, nurse, orthotist, and other) [
The foot complication outcome variables for this study were previous amputation, previous foot ulceration, peripheral arterial disease (PAD), peripheral neuropathy (PN), and foot deformity [
All data were analysed using SPSS 22.0 for Windows (SPSS Inc., Chicago, IL, USA) or GraphPad Software. Descriptive statistics were used to display all variables. Prevalence with 95% confidence intervals (95% CI) was evaluated for all foot complication outcome variables. Pearson’s chi-square tests and Student’s
Table
Proportion of the diabetes and nondiabetes participants with foot complications.
Foot complication | All |
Diabetes |
Nondiabetes |
|
---|---|---|---|---|
Participants | 733 | 172 | 561 | |
Foot complication(s)a | 336 (46.0% (42.4–49.7)) | 112 (65.5% (58.1–72.2) | 224 (40.1% (36.2–44.3)) | <0.001 |
Multiple foot complicationsb | 175 (23.9% (20.9–27.1)) | 66 (38.6% (31.6–46.1)) | 109 (19.5% (16.4–23.0)) | <0.001 |
Previous foot diseasec | 81 (11.1% (9.0–13.6)) | 38 (22.1% (16.5–28.9)) | 43 (7.7% (5.7–10.2)) | <0.001 |
Previous amputation | 30 (4.1% (2.9–5.8)) | 16 (9.3% (5.7–14.7)) | 14 (2.5% (1.4–4.2))) | <0.001 |
Previous foot ulcer | 72 (9.8% (7.9–12.2) | 35 (20.3% (15.0–27.0)) | 37 (6.6% (4.8–9.0))) | <0.001 |
Peripheral arterial disease | 153 (21.0% (18.2–24.1)) | 60 (35.1% (28.3–42.5)) | 93 (16.7% (13.8–20.0)) | <0.001 |
Peripheral neuropathy | 160 (22.0% (19.1–25.1)) | 74 (43.3% (36.1–50.8)) | 86 (15.4% (12.6–18.6)) | <0.001 |
Foot deformity | 158 (22.4% (19.5–25.6)) | 51 (30.5% (24.0–37.9)) | 107 (19.9% (16.7–23.5)) | 0.004 |
Thirty participants (4.1% (2.9–5.8%)) had a previous amputation (Table
Participant characteristics and univariate analysis for previous amputation and previous foot ulcer.
Variables | All | Previous amputation | Previous foot ulcer | ||||
---|---|---|---|---|---|---|---|
|
Odds ratio (95% CI) |
|
|
Odds ratio (95% CI) |
| ||
Participants | 733 | 30 / 731 (4.1%) | 72/731 (9.8%) | ||||
|
|||||||
Age: mean (SD) years | 62.0 (18.6) | 71.4 (11.1) | 1.04 (1.01–1.06) | 0.006 |
65.8 (15.6) | 1.01 (1.00–1.03) | 0.074 |
Age: median (IQR) years | 65 (50–76) | 72 (66–79) | 0.006 |
69 (57–76) | 0.128 |
||
Age groups | NA | 0.110 | |||||
18–40 years | 110 (15.0%) | 0 | 1.00 | 5 (6.9%) | 1.00 | ||
41–60 years | 188 (25.7%) | 6 (20.0%) | 19 (26.4%) | 2.38 (0.86–6.55) | 0.095 | ||
61–80 years | 316 (43.2%) | 17 (56.7%) | 39 (54.2%) | 2.97 (1.14–7.73) | 0.026 | ||
81+ years | 117 (16.0%) | 7 (23.3%) | 9 (12.5%) | 1.75 (0.57–5.39) | 0.330 | ||
Male sex | 408 (55.8) | 19 (63.3%) | 1.38 (0.65–2.95) | 0.400 | 46 (63.9%) | 1.46 (0.88–2.42) | 0.142 |
|
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|
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Socioeconomic status | 711 | 0.638 | 0.064 |
||||
Most disadvantaged | 102 (14.4%) | 6 (20.7%) | 1.00 | 16 (22.9%) | 1.00 | ||
Second most disadvantaged | 159 (22.4%) | 7 (24.1%) | 0.74 (0.24–2.26) | 0.593 | 17 (24.3%) | 0.64 (0.31–1.34) | 0.239 |
Middle | 98 (13.8%) | 2 (6.9%) | 0.33 (0.07–1.69) | 0.185 | 4 (5.7%) | 0.23 (0.07–0.72) | 0.011 |
Second least disadvantaged | 240 (33.8%) | 11 (37.9%) | 0.78 (0.28–2.16) | 0.626 | 26 (37.1%) | 0.66 (0.34–1.28) | 0.218 |
Least disadvantaged | 112 (15.8%) | 3 (10.3%) | 0.44 (0.11–1.81) | 0.255 | 7 (10.0%) | 0.36 (0.14–0.91) | 0.031 |
Geographic remoteness | 711 | 0.589 | 0.304 | ||||
Major city | 435 (61.2%) | 18 (62.1%) | 1.00 | 41 (58.6%) | 1.00 | ||
Inner regional area | 153 (21.5%) | 4 (13.8%) | 0.62 (0.21–1.86) | 0.392 | 15 (21.4%) | 1.04 (0.56–1.94) | 0.904 |
Outer regional area | 66 (9.3%) | 5 (17.2%) | 1.89 (0.68–5.28) | 0.224 | 12 (17.1%) | 2.13 (1.05–4.29) | 0.036 |
Remote area | 30 (4.2%) | 1 (3.4%) | 0.80 (0.10–6.17) | 0.826 | 0 | 0 | NA |
Very remote area | 27 (3.8%) | 1 (3.4%) | 0.89 (0.11–6.90) | 0.909 | 2 (2.9%) | 0.77 (0.18–3.35) | 0.722 |
<10-year education level | 395 (54.0%) | 19 (63.3%) | 1.48 (0.70–3.16) | 0.307 | 41 (56.9%) | 1.13 (0.69–1.85) | 0.621 |
Indigenous | 34 (4.6%) | 1 (3.3%) | 0.70 (0.09–5.27) | 0.727 | 4 (5.6%) | 1.23 (0.42–3.60) | 0.704 |
Born overseas | 161 (22.0%) | 5 (16.7%) | 0.70 (0.26–1.85) | 0.467 | 11 (15.3%) | 0.61 (0.31–1.19) | 0.146 |
|
|||||||
|
|||||||
Diabetes | 172 (23.5%) | 16 (53.3%) | 3.99 (1.91–8.36) | <0.001 |
35 (48.6%) | 3.60 (2.19–5.94) | <0.001 |
Hypertension | 359 (49.0%) | 21 (70.0%) | 2.54 (1.15–5.61) | 0.022 |
38 (52.8%) | 1.18 (0.73–1.93) | 0.497 |
Dyslipidaemia | 234 (31.9%) | 12 (40.0%) | 1.44 (0.68–3.04) | 0.341 | 27 (37.5%) | 1.31 (0.79–2.17) | 0.294 |
Myocardial infarct | 146 (19.9%) | 12 (40.0%) | 2.82 (1.33–6.00) | 0.007 |
17 (23.6%) | 1.27 (0.71–2.26) | 0.417 |
Cerebrovascular accident | 85 (11.6%) | 9 (30.0%) | 3.52 (1.59–7.97) | 0.002 |
8 (11.1%) | 0.95 (0.44–2.05) | 0.885 |
Chronic kidney disease | 89 (12.1%) | 11 (36.7%) | 4.62 (2.12–10.08) | <0.001 |
19 (26.4%) | 3.02 (1.69–5.39) | <0.001 |
Smoker | 104 (14.2%) | 3 (10.0%) | 0.66 (0.20–2.22) | 0.501 | 12 (16.7%) | 1.23 (0.64–2.38) | 0.533 |
Ex-smoker | 304 (41.5%) | 14 (46.7%) | 1.25 (0.60–2.60) | 0.554 | 28 (38.9%) | 0.89 (0.54–1.46) | 0.642 |
Cancer | 174 (23.7%) | 8 (26.7%) | 1.17 (0.51–2.68) | 0.707 | 17 (23.6%) | 0.99 (0.56–1.75) | 0.968 |
Arthritis | 274 (37.4%) | 18 (60.0%) | 2.64 (1.25–5.57) | 0.011 |
41 (56.9%) | 2.43 (1.49–3.99) | <0.001 |
Depression | 191 (26.1%) | 6 (20.0%) | 0.70 (0.28–1.75) | 0.447 | 21 (29.2%) | 1.18 (0.69–2.03) | 0.537 |
Acute foot trauma | 26 (3.5%) | 1 (3.3%) | 0.93 (0.12–7.12) | 0.946 | 7 (9.7%) | 3.63 (1.47–8.95) | 0.005 |
|
|||||||
|
|||||||
Mobility impairment | 242 (33.2%) | 21 (70.0%) | 5.07 (2.29–11.25) | <0.001 |
38 (52.8%) | 2.48 (1.52–4.05) | <0.001∗∗ |
Vision impairment | 110 (15.1%) | 12 (40.0%) | 4.09 (1.91–8.75) | <0.001 |
20 (27.8%) | 2.42 (1.38–4.25) | 0.002 |
Footwear worn: inside | 0.158 |
0.580 | |||||
Low-risk footwear | 81 (11.1%) | 6 (20.7%) | 1.00 | 11 (15.5%) | 1.00 | ||
Moderate-risk footwear | 263 (36.1%) | 13 (44.8%) | 0.65 (0.24–1.77) | 0.399 | 27 (38.0%) | 0.73 (0.34–1.54) | 0.407 |
High-risk footwear | 139 (19.1%) | 2 (6.9%) | 0.18 (0.04–0.93) | 0.041 | 12 (16.9%) | 0.61 (0.25–1.45) | 0.259 |
No footwear worn | 245 (33.7%) | 8 (27.6%) | 0.42 (0.14–1.26) | 0.121 | 21 (29.6%) | 0.60 (0.27–1.30) | 0.193 |
Footwear worn: outside | 0.116 |
0.235 | |||||
Low-risk footwear | 386 (53.2%) | 21 (75.0%) | 1.00 | 36 (50.7%) | 1.00 | ||
Moderate-risk footwear | 75 (10.3%) | 1 (3.6%) | 0.23 (0.03–1.77) | 0.159 | 11 (15.5%) | 1.67 (0.81–3.44) | 0.168 |
High-risk footwear | 250 (34.4%) | 5 (17.9%) | 0.35 (0.13–0.95) | 0.039 | 21 (29.6%) | 0.89 (0.51–1.56) | 0.682 |
No footwear worn | 15 (2.1%) | 1 (3.6%) | 1.24 (0.16–9.87) | 0.840 | 3 (4.2%) | 2.42 (0.65–8.99) | 0.186 |
|
|||||||
|
|||||||
Yes | 256 (34.9%) | 22 (73.3%) | 5.52 (2.42–12.60) | <0.001 |
56 (77.8%) | 8.03 (4.50–14.35) | <0.001 |
Podiatry | 180 (24.6%) | 18 (60.0%) | 50.3 (2.37–10.67) | <0.001 |
41 (56.9%) | 4.95 (2.99–8.18) | <0.001 |
GP | 93 (12.7%) | 14 (46.7%) | 6.89 (3.24–14.65) | <0.001 |
27 (37.5%) | 5.39 (3.14–9.26) | <0.001 |
Surgeon | 36 (4.9%) | 14 (46.7%) | 27.01 (11.73–62.15) | <0.001 |
17 (23.6%) | 10.41 (5.12–21.18) | <0.001 |
Physician | 21 (2.9%) | 5 (16.7%) | 8.56 (2.91–25.23) | <0.001 |
7 (9.7%) | 4.96 (1.93–12.73) | 0.001 |
Nurse | 20 (2.7%) | 7 (23.3%) | 16.11 (5.88–44.15) | <0.001 |
12 (16.7%) | 16.28 (6.40–41.37) | <0.001 |
Orthotist | 4 (0.5%) | 3 (10.0%) | 77.78 (7.83–772.35) | <0.001 |
2 (2.8%) | 9.39 (1.30–67.67) | 0.026 |
Other | 9 (1.2%) | 0 | 0 | NA | 1 (1.4%) | 1.15 (0.14–9.30) | 0.898 |
|
|||||||
|
|||||||
Previous foot ulcer | 72 (9.8%) | 21 (70.0%) | 30.33 (13.20–69.72) | <0.001 |
— | — | — |
|
|||||||
|
|||||||
Peripheral neuropathy | 160 (22.0%) | 21 (72.4%) | 10.65 (4.62–24.56) | <0.001 |
39 (54.9%) | 5.39 (3.24–8.95) | <0.001 |
PAD | 153 (21.0%) | 20 (69.0%) | 9.44 (4.20–21.20) | <0.001 |
40 (56.3%) | 6.20 (3.72–10.34) | <0.001 |
Foot deformity | 158 (22.4%) | 17 (65.4%) | 7.27 (3.17–16.66) | <0.001 |
29 (42.0%) | 2.85 (1.70–4.77) | <0.001 |
Independent factors associated with previous amputations (odds ratios [95% CI]).
Risk factor | Unadjusted |
|
Adjusteda |
|
---|---|---|---|---|
CVA history | 4.83 (1.48–15.74) | 0.009 |
6.85 [1.86–25.21] | 0.004 |
Previous foot ulcer | 17.92 (6.51–49.29) | <0.001 |
22.01 [6.89–70.38] | <0.001 |
Foot deformity | 4.50 (1.70–11.90) | 0.002 |
5.59 [1.89–16.55] | 0.002 |
Surgeon past foot treatment | 8.09 (2.50–26.20) | <0.001 |
10.73 [2.87–40.15] | <0.001 |
|
||||
Model 1 results | Pseudo |
Missing: 29 (4.0%); |
Pseudo |
Missing: 50 (6.8%); |
Previous foot ulcers were present in 72 participants (9.8% (7.9–12.2%)) (Table
Independent factors associated with previous foot ulcers (odds ratios [95% CI]).
Risk factor | Unadjusted |
|
Adjusteda |
|
---|---|---|---|---|
Vision impairment | 2.10 (1.09–4.03) | 0.026 |
1.89 (0.95–3.77) | 0.069 |
PN | 3.17 (1.81–5.56) | <0.001 |
3.75 (2.06–6.85) | <0.001 |
PAD | 3.77 (2.15–6.62) | <0.001 |
3.88 [2.14–7.06] | <0.001 |
Podiatry past foot treatment | 3.16 (1.80–5.55) | <0.001 |
2.88 (1.59–5.22) | <0.001 |
Nurse past foot treatment | 8.45 (2.88–24.84) | <0.001 |
18.80 (5.15–68.66) | <0.001 |
|
||||
Model 1 results | Pseudo |
Missing: 9 (1.2%); |
Pseudo |
Missing: 31 (4.2%); |
Peripheral arterial disease (PAD) was present in 153 participants (21.0% (18.2–24.1%)) (Table
Participant characteristics and univariate analysis for peripheral arterial disease, peripheral neuropathy, and foot deformity.
Variables | All | Peripheral arterial disease | Peripheral neuropathy | Foot deformity | ||||||
---|---|---|---|---|---|---|---|---|---|---|
|
Odds ratio |
|
|
Odds ratio |
|
|
Odds ratio |
| ||
Participants | 733 | 153/728 (21.0%) | 160/728 (22.0%) | 158/706 (22.4%) | ||||||
|
||||||||||
Age: mean (SD) years | 62.0 (18.6) | 70.5 (13.3) | 1.04 (1.03–1.05) | <0.001 |
70.1 (14.1) | 1.04 (1.02–1.05) | <0.001 |
72.3 (14.4) | 1.05 (1.04–1.06) | <0.001 |
Age: median (IQR) years | 65 (50–76) | 73 (63–81) | <0.001 |
73 (62–80) | <0.001 |
75 (66–82) | <0.001 |
|||
Age groups | <0.001 |
<0.001 |
<0.001 |
|||||||
18–40 years | 110 (15.0%) | 4 (2.6%) | 1.00 | 6 (3.8%) | 1.00 | 5 (3.2%) | 1.00 | |||
41–60 years | 188 (25.7%) | 28 (18.3%) | 4.70 (1.60–13.78) | 0.005 | 29 (18.2%) | 3.22 (1.29–8.03) | 0.012 | 19 (12.1%) | 2.33 (0.84–6.43) | 0.103 |
61–80 years | 316 (43.2%) | 82 (53.6%) | 9.41 (3.36–26.34) | <0.001 | 87 (54.7%) | 6.64 (2.81–15.69) | <0.001 | 88 (56.1%) | 7.84 (3.09–19.91) | <0.001 |
81+ years | 117 (16.0%) | 39 (25.5%) | 13.25 (4.55–38.62) | <0.001 | 37 (23.3%) | 8.02 (3.23–19.93) | <0.001 | 45 (28.7%) | 12.60 (4.76–33.36) | <0.001 |
Male sex | 408 (55.8) | 97 (63.4%) | 1.48 (1.03–2.14) | 0.037 |
93 (58.1%) | 1.12 (0.79–1.60) | 0.525 | 74 (46.8%) | 0.62 (0.44–0.89) | 0.009 |
|
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|
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Socioeconomic status | 711 | 0.020 |
0.798 | 0.274 | ||||||
Most disadvantaged | 102 (14.4%) | 32 (21.8%) | 1.00 | 24 (15.5%) | 1.00 | 22 (14.5%) | 1.00 | |||
Second most disadvantaged | 159 (22.4%) | 34 (23.1%) | 0.59 (0.33–1.04) | 0.066 | 34 (21.9%) | 0.88 (0.48–1.59) | 0.661 | 35 (23.0%) | 1.03 (0.56–1.89) | 0.927 |
Middle | 98 (13.8%) | 13 (8.8%) | 0.33 (0.16–0.67) | 0.002 | 21 (13.5%) | 0.86 (0.44–1.68) | 0.666 | 16 (10.5%) | 0.67 (0.33–1.36) | 0.264 |
Second least disadvantaged | 240 (33.8%) | 49 (33.3%) | 0.55 (0.32–0.93) | 0.025 | 56 (36.1%) | 0.97 (9.56–1.68) | 0.910 | 49 (32.2%) | 0.89 (0.51–1.58) | 0.698 |
Least disadvantaged | 112 (15.8%) | 19 (12.9%) | 0.43 (0.23–0.83) | 0.012 | 20 (12.9%) | 0.69 (0.35–1.34) | 0.272 | 30 (19.7%) | 1.40 (0.74–2.65) | 0.300 |
Geographic remoteness | 711 | 0.604 | 0.556 | 0.180 |
||||||
Major city | 435 (61.2%) | 87 (59.2%) | 1.00 | 98 (63.2%) | 1.00 | 103 (67.8%) | 1.00 | |||
Inner regional area | 153 (21.5%) | 30 (20.4%) | 0.98 (0.62–1.56) | 0.943 | 32 (20.6%) | 0.93 (0.59–1.46) | 0.742 | 28 (18.4%) | 0.73 (0.46–1.17) | 0.196 |
Outer regional area | 66 (9.3%) | 17 (11.6%) | 1.38 (0.76–2.51) | 0.297 | 10 (15.2%) | 0.61 (0.30–1.24) | 0.173 | 15 (9.9%) | 0.92 (0.50–1.71) | 0.793 |
Remote area | 30 (4.2%) | 5 (3.4%) | 0.79 (0.30–2.13) | 0.646 | 9 (5.8%) | 1.47 (0.65–3.30) | 0.357 | 2 (1.3%) | 0.23 (0.05–0.97) | 0.046 |
Very remote area | 27 (3.8%) | 8 (5.4%) | 1.67 (0.71–3.94) | 0.242 | 6 (3.9%) | 0.98 (0.38–2.49) | 0.961 | 4 (2.6%) | 0.53 (0.18–1.58) | 0.256 |
<10-year education level | 395 (54.0%) | 97 (63.4%) | 1.64 (1.14–2.37) | 0.008 |
92 (57.9%) | 1.23 (0.86–1.76) | 0.252 | 98 (62.0%) | 1.54 (1.07–2.21) | 0.020 |
Indigenous | 34 (4.6%) | 12 (7.9%) | 2.16 (1.04–4.46) | 0.039 |
9 (5.6%) | 1.29 (0.59–2.83) | 0.521 | 7 (4.5%) | 0.94 (0.40–2.20) | 0.881 |
Born overseas | 161 (22.0%) | 33 (21.6%) | 0.96 (0.62–1.47) | 0.839 | 29 (18.1%) | 0.73 (0.47–1.14) | 0.164 |
35 (22.3%) | 1.02 (0.67–1.56) | 0.925 |
|
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|
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Diabetes | 172 (23.5%) | 60 (39.2%) | 2.70 (1.84–3.96) | <0.001 |
74 (46.3%) | 4.18 (2.86–6.11) | <0.001 |
51 (32.3%) | 1.76 (1.20–2.63) | 0.004 |
Hypertension | 359 (49.0%) | 97 (63.4%) | 2.10 (1.45–3.03) | <0.001 |
92 (57.5%) | 1.55 (1.09–2.20) | 0.016 |
95 (60.1%) | 1.75 (1.22–2.50) | 0.002 |
Dyslipidaemia | 234 (31.9%) | 66 (43.1%) | 1.87 (1.30–2.70) | 0.001 |
65 (40.6%) | 1.63 (1.13–2.34) | 0.008 |
53 (33.5%) | 1.09 (0.75–1.58) | 0.671 |
Myocardial infarct | 146 (19.9%) | 42 (27.5%) | 1.73 (1.15–2.62) | 0.009 |
38 (23.8%) | 1.33 (0.87–2.02) | 0.187 |
43 (27.2%) | 1.66 (1.10–2.50) | 0.016 |
Cerebrovascular accident | 85 (11.6%) | 29 (19.0%) | 2.17 (1.33–3.54) | 0.002 |
24 (15.0%) | 1.47 (0.88–2.44) | 0.140 |
21 (13.3%) | 1.22 (0.72–2.08) | 0.456 |
Chronic kidney disease | 89 (12.1%) | 38 (24.8%) | 3.47 (2.17–5.54) | <0.001 |
32 (20.0%) | 2.24 (1.40–3.61) | 0.001 |
28 (17.7%) | 1.79 (1.09–2.91) | 0.020 |
Smoker | 104 (14.2%) | 21 (13.7%) | 0.96 (0.57–1.60) | 0.866 | 18 (11.3%) | 0.72 (0.42–1.24) | 0.235 | 10 (6.3%) | 0.35 (0.18–0.69) | 0.002 |
Ex-smoker | 304 (41.5%) | 69 (45.1%) | 1.21 (0.84–1.73) | 0.308 | 66 (41.3%) | 0.98 (0.69–1.40) | 0.914 | 68 (43.0%) | 1.07 (0.75–1.53) | 0.717 |
Cancer | 174 (23.7%) | 29 (19.0%) | 0.71 (0.45–1.10) | 0.127 |
45 (28.1%) | 1.35 (0.90–2.00) | 0.143 |
39 (24.7%) | 1.09 (0.72–1.64) | 0.694 |
Arthritis | 274 (37.4%) | 77 (50.3%) | 1.99 (1.39–2.86) | <0.001 |
73 (45.6%) | 1.57 (1.10–2.24) | 0.013 |
82 (51.9%) | 2.24 (1.55–3.19) | <0.001 |
Depression | 191 (26.1%) | 36 (23.5%) | 0.85 (0.56–1.29) | 0.440 | 41 (25.6%) | 0.97 (0.65–1.45) | 0.877 | 44 (27.8%) | 1.09 (0.74–1.63) | 0.660 |
Acute foot trauma | 26 (3.5%) | 5 (3.3%) | 0.89 (0.33–2.40) | 0.820 | 9 (5.6%) | 1.93 (0.84–4.42) | 0.119 |
6 (3.8%) | 1.04 (0.41–2.64) | 0.931 |
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|
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Mobility impairment | 242 (33.2%) | 78 (51.0%) | 2.66 (1.84–3.83) | <0.001 |
95 (59.4%) | 4.23 (2.93–6.12) | <0.001 |
89 (56.3%) | 3.59 (2.49–5.19) | <0.001 |
Vision impairment | 110 (15.1%) | 37 (24.2%) | 2.22 (1.42–3.46) | <0.001 |
33 (20.6%) | 1.68 (1.07–2.64) | 0.026 |
37 (23.6%) | 2.14 (1.37–3.34) | 0.001 |
Footwear worn: inside | 0.002 |
0.006 |
0.007 |
|||||||
Low-risk footwear | 81 (11.1%) | 19 (12.4%) | 1.00 | 27 (17.0%) | 1.00 | 22 (13.9%) | 1.00 | |||
Moderate-risk footwear | 263 (36.1%) | 74 (48.4%) | 1.28 (0.72–2.28) | 0.408 | 66 (41.5%) | 0.67 (0.39–1.16) | 0.151 | 73 (46.2%) | 1.07 (0.61–1.87) | 0.813 |
High-risk footwear | 139 (19.1%) | 19 (12.4%) | 0.53 (0.26–1.06) | 0.074 | 25 (15.7%) | 0.44 (0.24–0.83) | 0.012 | 23 (14.6%) | 0.56 (0.29–1.08) | 0.083 |
No footwear worn | 245 (33.7%) | 41 (26.8%) | 0.66 (0.36–1.21) | 0.178 | 41 (25.8%) | 0.40 (0.23–0.71) | 0.002 | 40 (25.3%) | 0.56 (0.31–1.01) | 0.054 |
Footwear worn: outside | 0.065 |
0.015 |
0.316 | |||||||
Low-risk footwear | 386 (53.2%) | 89 (58.6%) | 1.00 | 91 (57.2%) | 1.00 | 85 (54.1%) | 1.00 | |||
Moderate-risk footwear | 75 (10.3%) | 19 (12.5%) | 1.13 (0.64–2.01) | 0.670 | 16 (10.1%) | 0.88 (0.48–1.60) | 0.674 | 22 (14.0%) | 1.43 (0.82–2.49) | 0.207 |
High-risk footwear | 250 (34.4%) | 39 (25.7%) | 0.62 (0.41–0.94) | 0.026 | 44 (27.7%) | 0.70 (0.47–1.05) | 0.081 | 47 (29.9%) | 0.81 (0.55–1.21) | 0.313 |
No footwear worn | 15 (2.1%) | 5 (3.3%) | 1.67 (0.56–5.01) | 0.361 | 8 (5.0%) | 3.71 (1.31–10.50) | 0.014 | 3 (1.9%) | 0.92 (0.25–3.38) | 0.901 |
|
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|
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Yes | 256 (34.9%) | 83 (54.2%) | 2.80 (1.95–4.04) | <0.001 |
86 (53.8%) | 2.77 (1.93–3.96) | <0.001 |
86 (54.4%) | 2.80 (1.95–4.02) | <0.001 |
Podiatry | 180 (24.6%) | 62 (40.5%) | 2.67 (1.82–3.91) | <0.001 |
67 (41.9%) | 2.93 (2.01–4.27) | <0.001 |
73 (46.2%) | 3.71 (2.54–5.42) | <0.001 |
GP | 93 (12.7%) | 36 (23.5%) | 2.85 (1.79–4.54) | <0.001 |
37 (23.1%) | 2.81 (1.77–4.45) | <0.001 |
25 (15.8%) | 1.42 (0.86–2.25) | 0.168 |
Surgeon | 36 (4.9%) | 20 (13.1%) | 5.61 (2.80–11.26) | <0.001 |
18 (11.3%) | 4.11 (2.07–8.18) | <0.001 |
14 (8.9%) | 2.71 (1.33–5.53) | 0.006 |
Physician | 21 (2.9%) | 9 (5.9%) | 2.93 (1.21–7.09) | 0.017 |
8 (5.0%) | 2.25 (0.92–5.52) | 0.078 |
9 (5.7%) | 2.95 (1.20–7.25) | 0.018 |
Nurse | 20 (2.7%) | 10 (6.5%) | 3.95 (1.61–9.68) | 0.003 |
11 (6.9%) | 4.59 (1.87–11.27) | 0.001 |
9 (5.7%) | 3.25 (1.30–8.14) | 0.012 |
Orthotist | 4 (0.5%) | 1 (0.7%) | 1.25 (0.13–12.14) | 0.845 | 3 (1.9%) | 10.83 (1.12–104.88) | 0.040 | 1 (0.6%) | 1.74 (0.16–19.30) | 0.652 |
Other | 9 (1.2%) | 2 (1.3%) | 1.08 (0.22–5.23) | 0.929 | 1 (0.6%) | 0.44 (0.06–3.55) | 0.441 | 3 (1.9%) | 1.75 (0.43–7.07) | 0.433 |
|
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|
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Peripheral neuropathy | 160 (22.0%) | 62 (40.5%) | 3.35 (2.27–4.95) | <0.001 |
— | — | — | 66 (42.0%) | 3.69 (2.50–5.45) | <0.001 |
PAD | 153 (21.0%) | — | — | — | 62 (39.0%) | 3.35 (2.27–4.95) | <0.001 |
53 (33.8%) | 2.43 (1.63–3.62) | <0.001 |
Foot deformity | 158 (22.4%) | 52 (35.8%) | 2.43 (1.63–3.62) | <0.001 |
66 (42.3%) | 3.69 (2.50–5.45) | <0.001 |
— | — | — |
Independent factors associated with peripheral arterial disease (odds ratios [95% CI]).
Risk factor | Unadjusted |
|
Adjusteda |
|
---|---|---|---|---|
Age groups | <0.001 |
<0.001 |
||
18–40 years | Referent | Referent | ||
41–60 years | 4.98 (1.64–15.14) | 0.005 |
4.69 (1.55–14.23) | 0.006 |
61–80 years | 10.42 (3.56–30.51) | <0.001 |
8.94 (3.04–26.33) | <0.001 |
81+ years | 15.61 (5.10–47.80) | <0.001 |
12.72 (4.10–39.40) | <0.001 |
Male sex | 1.55 (1.04–2.32) | 0.031 |
1.70 (1.13–2.56) | 0.012 |
Indigenous | 3.23 (1.40–7.43) | 0.006 |
3.12 (1.36–7.18) | 0.007 |
Cancer history | 0.52 (0.32–0.85) | 0.009 |
0.52 (0.32–0.84) | 0.008 |
PN | 2.38 (1.56–3.61) | <0.001 |
2.26 (1.48–3.45) | <0.001 |
Surgeon past foot treatment | 6.01 (2.74–13.18) | <0.001 |
5.16 (2.32–11.47) | <0.001 |
|
||||
Model 1 results | Pseudo |
Missing: 11 (1.5%); |
Pseudo |
Missing: 11 (1.5%); |
Peripheral neuropathy (PN) was present in 160 participants (22.0% (19.1–25.1%)) (Table
Independent factors associated with peripheral neuropathy (odds ratios [95% CI]).
Risk factor | Unadjusted |
|
Adjusteda |
|
---|---|---|---|---|
Age groups | 0.007 |
0.008 |
||
18–40 years | Referent | Referent | ||
41–60 years | 2.93 (1.07–8.01) | 0.037 |
2.77 (1.01–7.62) | 0.048 |
61–80 years | 4.66 (1.80–12.08) | 0.002 |
4.55 (1.75–11.80) | 0.002 |
81+ years | 4.73 (1.70–13.15) | 0.003 |
4.42 (1.59–12.32) | 0.004 |
Diabetes | 3.91 (2.57–5.97) | <0.001 |
3.94 (2.55–6.07) | <0.001 |
Mobility impairment | 3.37 (2.22–5.11) | <0.001 |
3.41 (2.24–5.20) | <0.001 |
PAD | 1.93 (1.25–2.99) | 0.003 |
2.08 (1.33–3.25) | 0.001 |
Outside footwear worn | 0.017 |
0.055 | ||
Low risk | Referent | Referent | ||
Moderate risk | 0.58 (0.29–1.15) | 0.117 | 0.57 (0.28–1.13) | 0.108 |
High risk | 0.71 (0.45–1.11) | 0.132 | 0.72 (0.45–1.14) | 0.158 |
No footwear | 3.99 (1.19–13.35) | 0.025 |
3.01 (0.85–10.65) | 0.088 |
|
||||
Model 1 results | Pseudo |
Missing: 15 (2.0%); |
Pseudo |
Missing: 33 (4.5%); |
Foot deformity was present in 158 participants (22.4% (19.5–25.6%)) (Table
Independent factors associated with foot deformity (odds ratios [95% CI]).
Risk factor | Unadjusted |
|
Adjusteda |
|
---|---|---|---|---|
Age groups | <0.001 |
No confounders identified | ||
18–40 years | Referent | |||
41–60 years | 1.76 (0.62–4.99) | 0.289 | ||
61–80 years | 4.67 (1.79–12.17) | 0.002 |
||
81+ years | 5.68 (2.05–15.71) | 0.001 |
||
Mobility impairment | 2.04 (1.35–3.08) | 0.001 |
||
PN | 2.20 (1.44–2.36) | <0.001 |
||
Podiatry past foot treatment | 2.06 (1.36–3.12) | 0.001 |
||
|
||||
Model 1 results | Pseudo |
Missing: 32 (4.4%); |
This appears to be the first study to investigate a representative inpatient population for foot complications. Our findings indicate nearly half (46%) of all inpatients had at least one foot complication that places them at risk of developing active foot disease, including nearly a quarter (24%) at higher risk with multiple foot complications and a tenth (11%) at very high risk of developing active foot disease with a history of previous foot disease. Inpatients with diabetes had significantly higher proportions of all foot complications than those without diabetes; however, interestingly, there were more patients with foot complications that did not have diabetes than did have diabetes due to the greater overall proportion of inpatients without diabetes. Foot complications in inpatients were associated with older age, males, indigenous peoples, diabetes, cerebrovascular accident (CVA) history, mobility impairment, other foot complications, and past foot treatment. Overall, these findings suggest that foot complications are relatively common in inpatient populations and also have common factors independently associated with them in both diabetes and nondiabetes inpatients.
To the best of our knowledge, the only foot complication to have been previously investigated in a representative inpatient population was PAD [
Although previous amputation, previous foot ulceration, PN, and foot deformity have not been previously investigated in representative inpatient populations, our findings are generally consistent to those reported for diabetes and geriatric inpatient populations [
There has also been a general lack of literature investigating independent factors associated with foot complications in representative populations (inpatient or outpatients with and without diabetes). Yet interestingly, our representative inpatient findings for factors associated with foot complications were very similar to previously reported diabetes outpatient findings, even after we adjusted for diabetes. We found previous amputation was most strongly associated with previous foot ulcers which have been consistently identified in the diabetes literature to be the major precipitating risk factor for amputation [
The independent factors we identified to be associated with previous foot ulceration were also consistent with those reported in the diabetes outpatient literature [
PAD in our study was independently associated with older age, male gender, and PN, which is consistent with previous outpatient literature [
PN was found to be independently associated with older age, diabetes, and mobility impairment in our study, again all of which have been reported in the diabetes outpatient literature [
Our overall findings suggest that foot complications that have been commonly reported to precipitate the development of active foot disease in the community are also present frequently in the inpatient population and have common factors independently associated with them, regardless of diabetes. Further research is recommended to more precisely determine the causal relationships for foot complications in nondiabetes populations in particular. It is recommended that policy makers and clinicians adopt simple hospital triage procedures that identify inpatients with these foot complications early to ensure that they do not develop into future active foot disease, falls, or pressure injuries whilst in hospital [
Additionally, although the independent associations between past foot treatment and most foot complications appear encouraging in our findings, this was not the case for PN. It could be argued that PN is the most critical foot complication that leads to active foot disease, falls, and pressure injuries, and thus, best practice guidelines need to better highlight that patients with PN require ongoing monitoring to ensure they can identify problems early to prevent possible future hospitalisation [
This study has a number of strengths and limitations which have been discussed elsewhere [
This study was the first to investigate multiple foot complications in a representative inpatient population. It identified that half of all inpatients had at least one-foot complication, with a quarter having multiple foot complications, which have been reported to be risk factors for the development active foot disease, pressure injuries, or falls whilst in hospital. The findings of this study suggest that regardless of having diabetes or not, common factors precipitate these foot complications. It is recommended that all inpatients are screened for these common foot complications on admission, particularly those with diabetes, and are managed accordingly to potentially prevent the large burden that foot disease already imposes on inpatient and outpatient populations.
The authors declare that there is no conflict of interest regarding the publication of this article.
This work was kindly supported by grant funding from Queensland Health (Queensland Government, Australia) and the Wound Management Innovation Cooperative Research Centre (Australia). The authors also wish to warmly acknowledge the tireless work of the Queensland’s health-employed podiatrists and Queensland University of Technology podiatry students that undertook training, testing, and data collection for this project. Without their enthusiasm, this study would not have been possible.