Peculiarities of the Formation of Unilateral Diabetic Trophic Ulcers

Background. An estimated 19%-34% of people with diabetes develop foot ulcers during their lifetime, with around 20% requiring lower limb amputation. Diabetic trophic ulcers are typically unilateral, suggesting a foot-specific factor triggering the destructive changes in the foot. The aim of the study was to assess the odds and risks of unilateral trophic ulcer formation in diabetic patients, based on the evaluation of the leg length discrepancy and the resulting asymmetric load distribution between the longer and shorter limbs. Materials and methods. The study involved 53 diabetic patients without plantar ulcers and 46 with unilateral plantar trophic ulcers, comparable in age, gender, and body mass index. A device with a tripod for a mobile phone, equipped with a “virtual ruler” app, was used to measure leg length. Data analysis was performed using SPSS 27.0 software. Results. There was no statistically significant difference in mean leg length discrepancy between the two studied groups (p = 0,157). The distribution of patients with different degrees of anisomelia was also similar between groups (χ2= 0,36; p = 0,835). Among 34 patients with trophic ulcers (73,9%) who had anisomelia, plantar ulcer formation was observed on the shorter limb in 30 patients (65,2%) and on the longer limb in 4 patients (8,7%). The odds ratio was 3,57 (95% CI, 1,14–11,18), indicating that the patient with the shorter leg had significantly higher odds of developing a trophic ulcer (p = 0,025). The relative risk for ulcer development on the shorter leg was 1,89 (95% CI, 1,04–3,43), indicating that the risk of occurrence of a trophic ulcer was higher in persons with the shorter leg compared to those without such factor. Conclusions. Diabetic patients with anisomelia have significantly higher odds and risks of trophic ulcer formation at the shorter leg. This suggests that asymmetric load distribution plays a crucial role in unilateral trophic ulcer development.