Serum vitamin D and diabetic foot complications

ABSTRACT

Background: Foot complications such as ulceration and neuropathy are common complications of diabetes mellitus (DM). Previous reports have demonstrated a possible increased risk of these complications in diabetic patients with low levels of serum vitamin D.Objectctive: The purpose of this study is to compare serum vitamin D levels in diabetic patients with and without Charcot neuroarthropathy (CN), peripheral arterial disease (PAD), infection (DFI), ulceration (DFU), and peripheral neuropathy (DPN).

Design: A retrospective chart review of all patients undergoing foot and ankle surgery with a history of DM over a 13 month period was performed. From this cohort, fifty subjects with CN were matched with 50 without CN and preoperative lab values were compared. A secondary evaluation was performed on the subjects’ other comorbidities including PAD, DFI, DFU, and DPN.

Results: Seventy-eight percent of our patients had vitamin D deficiency or insufficiency. Preoperative serum vitamin D levels were not significantly different between diabetic patients with and without CN (p = 0.55). Diabetic patients with PAD (p = 0.03), DFI (p = 0.0006), and DFU (p = 0.04) were all found to have significantly lower serum vitamin D levels than diabetic patients without these complications. Lower levels of serum albumin and higher serum creatinine were also noted with subjects with PAD, DFI, DPN, and DFU. While seasonal serum vitamin D level fluctuation was noted, this difference did not reach statistical significance with the numbers available.

Conclusion: We found various lower extremity complications to be associated with low serum vitamin D including PAD, DFI, and DFU. While other studies have questioned the role of vitamin D and CN, we were unable to identify any significant difference between diabetic patients with and without Charcot neuroarthropathy.

Level of evidence: Level 2

KEYWORDS:

• Charcot
• neuroarthropathy (CN)
• diabetic peripheral neuropathy (DPN)
• diabetic foot infection (DFI)
• diabetic foot ulcer (DFU)
• peripheral arterial disease (PAD)
• vitamin D

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Robert M. Greenhagen

Robert M Greenhagen, DPM is the Director of the Midwest Foot and Ankle Fellowship and an adjunct clinical professor for the College of Podiatric Medicine and Surgery at Des Moines University.  He is a podiatric surgeon at the Foot and Ankle Center of Nebraska and Iowa, as well as, the VA Nebraska-Western Iowa Health Care System.

Robert G. Frykberg

Robert G Frykberg, DPM, is an Adjunct Professor, Midwestern University Program in Podiatric Medicine.

Dane K. Wukich

Dane K. Wukich, MD, is Professor and Chair of the Department of Orthopaedic Surgery at UT Southwestern, where he holds the Dr. Charles F. Gregory Chair in Orthopaedic Surgery. He is also the Medical Director of Orthopaedic Surgery at UT Southwestern University Hospitals.