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Prevalence of Equinus in Diabetic versus Nondiabetic Patients

Robert G. Frykberg DPM, MPH1,2, Joel Bowen DPM1,2, Jared Hall DPM1, Arthur Tallis DPM1, Edward Tierney DPM1,2, and Denise Freeman DPM, MSE1,2
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  • 1 Podiatry Department, Carl T. Hayden Veterans Affairs Medical Center, Phoenix, AZ.
  • | 2 Arizona Podiatric Medicine Program, Midwestern University College of Health Sciences, Glendale, AZ.
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Background:

There are no conclusive data to support the contention that diabetic patients have an increased frequency of ankle equinus compared with their nondiabetic counterparts. Additionally, a presumed contributing cause of foot ulceration is ankle joint equinus. Therefore, we sought to determine whether persons with diabetes have a higher prevalence of ankle joint equinus than do nondiabetic persons.

Methods:

A prospective pilot survey of 102 outpatients (43 diabetic and 59 nondiabetic) was conducted. Demographic and historical data were obtained. Each patient underwent a standard lower-extremity examination, including the use of a biplane goniometer to measure ankle joint range of motion.

Results:

Equinus, defined as ankle dorsiflexion measured at 0° or less, was found in 24.5% of the overall population. In the diabetes cohort, 16 of 43 patients (37.2%) were affected compared with 9 of 59 nondiabetic participants (15.3%) (P = .011). There was a threefold risk of equinus in the diabetic population (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.28–8.44; P < .013). The equinus group had a history of ulceration in 52.0% compared with 20.8% of the nonequinus group (P = .003). Equinus, therefore, imparted a fourfold risk of ulceration (OR, 4.13; 95% CI, 1.58–10.77; P < .004). We also found a 2.8 times risk of equinus in patients with peripheral neuropathy (OR, 2.8; 95% CI, 1.11–7.09; P < .029).

Conclusions:

Equinus may be more prevalent in diabetic patients than previously reported. Although we cannot prove causality, we found a significant association between equinus and ulceration. (J Am Podiatr Med Assoc 102(2): 84–88, 2012)

Corresponding author: Robert G. Frykberg, DPM, MPH, Carl T. Hayden Veterans Affairs Medical Center, 650 E Indian School Rd, Phoenix, AZ 85012. (E-mail: Robert.Frykberg@med.va.gov)