The prevalence of risk factors for foot ulceration in Egyptian diabetic patients

The effect of ethnicity on diabetic foot ulceration (DFU), neuropathy and peripheral arterial disease (PAD) remains controversial, with few previous studies from Egypt. The aim of this study was to examine the prevalence of DFU and its risk factors in a cohort of patients presented to the outpatient diabetes clinic at Mansoura University Specialized Medical Hospital. Over a period of 12 months, 1220 diabetic patients were screened for DFU, neuropathy, PAD, foot deformities, and skin and nail abnormalities. The mean age was 50.5 ± 10.9 years and 36.8% were male. Diabetes duration was 7.9 ± 5.9 years and BMI 34.5 ± 6.7. The prevalence of active or past foot ulceration was 1.2% and 5.7% respectively. Monofilament insensitivity was found in 124 patients (10.2%). Only 38 patients (3.1%) had absent foot pulses. We found dry skin in 544 patients (44.6%), calluses in 69 (5.7%), tinea pedis in 532 (43.6%) and thick nails in 215 (17.6%); 61.6% of our patients used inappropriate footwear and 93.8% received no prior foot education. It was concluded that, despite the low prevalence of neuropathy and PAD in our diabetic patients, the prevalence of DFU is still high. The lack of knowledge regarding diabetic foot problems, inappropriate footwear and the high prevalence of skin and nail pathology in Egypt could explain this paradox. It is suggested that regional differences in the risk factors for DFU should be considered when preventative strategies are planned.