Skin breakdown of the feet in patients with spina bifida: Analysis of risk factors.
Michael J Conklin, Betsy Hopson, Anastasia Arynchyna and 3 others
PMID 30507590WHAT IT FOUND
Myelomeningocele diagnosis and higher neurologic lesion levels significantly increase the risk of foot skin breakdown in children with spina bifida.
Ambulation status was not an independent risk factor, contradicting the hypothesis that walking causes these wounds.
Key findings
01Patients with myelomeningocele had a significantly higher rate of foot skin breakdown (22.5%) compared to non-myelomeningocele patients (4.4%).
02In multivariate analysis, diagnosis of myelomeningocele (odds ratio 3.75) and functional lesion level at lumbar or above were significant risk factors for foot skin breakdown.
03Ambulation status was not independently significant for foot skin breakdown, despite being significant on univariate analysis.
STILL TO COME
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What it does not show
The study is retrospective and relies on parental recall for the presence of skin breakdown in the last 12 months. Foot shape was only recorded for patients who had skin breakdown, so it is impossible to determine if non-plantigrade feet are a risk factor. The study cannot determine the relationship between foot surgery and breakdown because the timing and sidedness of surgery relative to breakdown were not specified. Data comes from a single clinic in Alabama, which may not be representative of a national sample.
Declared interests
The authors declare no conflicts of interest. The study was supported by the National Institutes of Health and non-U.S. government grants.
The easy way to misread this
Do not conclude that corrective foot surgery prevents skin breakdown. The study found a high proportion of non-plantigrade feet among those with breakdown, but because foot shape was not recorded for patients without breakdown, it cannot prove that non-plantigrade feet cause the wounds.