J Korean Orthop Assoc.  2018 Apr;53(2):136-142. 10.4055/jkoa.2018.53.2.136.

The Relationship between Body Mass Index and Diabetic Foot Ulcer, Sensory, Blood Circulation of Foot on Type II Diabetes Mellitus Patients

• Park YK
• Lee JY
• Jung S
• Ryu KH

• KMID: 2410061
• DOI: http://doi.org/10.4055/jkoa.2018.53.2.136

Abstract

PURPOSE
Excessive weight bearing from obesity may induce pains in the lower extremity and resulting functional abnormality. Here we aimed to identify the relationship, it is intended to identity relationship obesity has with diabetic foot ulcer, sensory function, and blood circulation in diabetic patients.
MATERIALS AND METHODS
We included patients who hospitalized or visited the department of orthopedic surgery for the treatment of diabetic foot ulcer, between January 2010 and December 2015. Among them, those aged over 30 years, diagnosed with diabetes with a progression of more than one year, and an HbA1c level of less than 7.5% were included for final analysis. For obesity, body mass index (BMI) was used, those with a BMI of over 18.5 kg/m2 were included. Using the Asian cut point of World Health Organization, patients were classified into normal, overweight, or obese. For foot ulcers, patients were classified using the Wagner ulcer classification. For sensory function, it was measured by scoring it with Semmes-Weinstein monofilament of International Working Group on the Diabetic Foot (IWGDF). Moreover for blood circulation, ankle-brachial index (ABI) was measured.
RESULTS
For the sensory function, it was found that the overweight group obtained the highest score and the obesity group obtained the lowest score. For ABI, the overweight group scored the highest and the normal group scored the lowest. Moreover diabetic foot ulcer was the highest in the obesity group and the lowest in the normal group. From these results, it was considered that BMI had no relationship with sensory or blood circulation of the feet. However, the relationship between the diabetic foot ulcer and BMI showed statistical significance; according to the result of regression analysis, BMI of diabetic patients had a positive correlation with diabetic foot ulcer.
CONCLUSION
This study showed that the sensory function and blood circulation of the feet had no relationship with diabetic foot ulcer; however, BMI appears to have a positive correlation with diabetic foot ulcer. Moreover, it seems to be a good index for determining the risk of diabetic foot ulcer.

Keyword

body mass index; diabetic foot; foot ulcer; sensation; blood circulation

MeSH Terms

Ankle Brachial Index
Asian Continental Ancestry Group
Blood Circulation*
Body Mass Index*
Classification
Diabetes Mellitus*
Diabetic Foot*
Foot Ulcer
Foot*
Humans
Lower Extremity
Obesity
Orthopedics
Overweight
Sensation
Ulcer*
Weight-Bearing
World Health Organization

Figure

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  Figure 1 Patients were classified depending on the degree of their ulcer using the Wagner ulcer classification method. (A) Wagner grade 2. (B) Wagner stage 5.

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  Figure 2 Sensory was measured by scoring it (0–4 points) with Semmes-Weinstein monofilament to measure sensory state of feet.

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  Figure 3 The ankle-brachial index was measured to use it as an index for blood circulation.

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