The prevalence and risk factors for foot pressure ulcers in ambulatory pediatric patients with spina bifida.

Aim: To determine prevalence, incidence and risk factors for foot pressure ulcers in ambulatory children with spina bifida. Method: Retrospective cohort study of 72 ambulatory children (age range 0-23.9 years) with spina bifida treated at a pediatric tertiary care facility. Data on foot pressure ulcers were recorded and analyzed to determine prevalence, incidence and predictive factors.

Results: Foot pressure ulcers occurred in 50/143 limbs (35%) over 10.5 ± 3.5 years. Average incidence was 0.10 foot pressure ulcer incidents per person-year, and prevalence in years with complete follow-up was 8.8%. Prevalence was related to age [higher for ages 11-15 (17%), than ages 0-10 (5%) and 16+ years (7%), p < 0.0001], and varus/valgus foot deformities (p < 0.001) and brace use (0.32 risk difference, p = 0.01), but not with standing foot position, deformity rigidity, body mass index, spina bifida type, lesion level, ambulatory level or co-morbidities. Most common sites were the heel (21/96, 22%), lateral malleolus (12/96, 13%), and plantar 5th metatarsal head (11/96, 12%).

Conclusion: Foot pressure ulcers occur in nearly 1 out of 10 ambulatory children with spina bifida, most often in pre-teens or young teen-agers with foot deformities, who use braces. This information can help direct skin care education and prevention to those most vulnerable.Implications for RehabilitationFoot pressure ulcers occur in children and adolescents with spina bifida, most commonly in those aged 11-15 years, with foot deformities and who use braces.Ulcer development was unrelated to stiffness of foot deformity, body mass index, lesion or functional level, or presence of comorbidities such as Arnold-Chiari malformation, syringomyelia or shunted hydrocephalus.Skin care education and preventative measures should be provided to all patients, but with particular emphasis for those with these risk factors.