Factors associated with deep foot fissures in diabetic patients: A cross-sectional observational study

Background: Foot ulcers can develop from fissures in patients with diabetes. It is generally considered that fissures can develop with dry skin due to decreased perspiration associated with autonomic neuropathy. Especially, deep fissures that extend into the dermis may have a higher risk of ulceration than superficial fissures because of damage of skin barrier function. However, distinctions between superficial and deep fissures have not been well described, and specific factors involved in their development are generally unknown.. Objective: To investigate factors associated with the superficial and deep foot fissures in patients with diabetes. Design and methods: This cross-sectional observational study involved 578 patients with diabetes evaluated at a university hospital between September 2007 and March 2008. Patients with foot ulcers or foot defects due to amputation were excluded. Superficial fissures were defined as narrow skin cracks limited to the epidermis. Deep fissures were defined as narrow, deep, linear skin cracks extending to the dermis, possibly with higher ulceration risk than superficial fissures. Logistic regression analysis was performed to analyze factors associated with the depth (superficial or deep) of foot fissures. Results: The prevalence of superficial fissures was 9.0%, and that of deep fissures was 3.8%. Presence of superficial fissures was correlated with autonomic neuropathy (OR 2.35, 95% Cl 1.20-4.59, p = 0.012). Notably, presence of deep fissures was correlated with autonomic neuropathy and angiopathy (OR 2.88, 95% Cl 1.11-7.48, p = 0.030; and OR 3.29, 95% Cl 1.30-8.35, p = 0.012, respectively). Conclusions: Our new finding of a correlation between deep fissures and angiopathy suggests that control of blood supply should be effective for preventing deep fissures prone to ulceration. In the future, elucidation of the mechanism of the angiopathy-induced deep fissures will be needed to promote more effective preventive care of fissures. (C) 2012 Elsevier Ltd. All rights reserved.