Temporal trends of selected diabetic foot deformities and risk factors: an exploratory analysis from a tertiary diabetes clinic

AIMS: While classical diabetic foot risk factors are well established, their temporal progression remains insufficiently understood, particularly for deformities. Therefore, we aimed to analyze trends in selected diabetic foot risk factors and to design a practical monitoring model for long-term clinical use. METHODS: From 51,001 routine foot examinations at tertiary diabetes clinic (1998-2024), we included 14,436 screenings from 3,049 patients with complete data. Using generalized estimating equations, we modelled the temporal trends in the prevalence of six diabetes-related complications. RESULTS: Loss of Protective Sensation (LOPS) significantly increased the odds (adjusted for age at diagnosis, sex, diabetes type, and duration) of five complications: fat pad atrophy (OR = 2.12), toenail deformity (OR = 2.44), toe deformities (OR = 2.57), callus (OR = 3.66), and xerosis (OR = 2.27). Toenail deformity was the most prevalent complication, while fat pad atrophy showed the steepest relative increase over time. Female sex was a risk factor for specific deformities and fat pad atrophy but protective against xerosis (OR = 0.76). CONCLUSION: The developed models provide clinically actionable risk trajectories, revealing distinct patterns by complication type, LOPS status, and demographic factors. These findings can directly support targeted screening protocols and inform resource allocation.