Incidence of Falls, Risk Factors for Falls, and Fall-Related Fractures in Individuals With Diabetes and a Prior Foot Ulcer

  1. Carolyn Wallace, PHD1,
  2. Gayle E. Reiber, MPH, PHD123,
  3. Joseph LeMaster, MD24,
  4. Douglas G. Smith, MD5,
  5. Katrina Sullivan, DPM6,
  6. Shane Hayes, CPED1 and
  7. Christy Vath, BS1
  1. 1Health Services and Rehabilitation Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington
  2. 2Department of Health Services, University of Washington, Seattle, Washington
  3. 3Department of Epidemiology, University of Washington, Seattle, Washington
  4. 4Department of Family Medicine, University of Washington, Seattle, Washington
  5. 5Department of Orthopedic Surgery, University of Washington, Seattle, Washington
  6. 6Joslin Diabetes Center at Swedish Medical Center, Seattle, Washington


    OBJECTIVE—To describe the incidence of falls, risk factors for falls, and the frequency of fall-related fractures in a cohort of individuals with diabetes and a prior foot ulcer.

    RESEARCH DESIGN AND METHODS—A total of 400 individuals with diabetes and a prior foot ulcer were recruited from two western Washington State health care organizations and followed prospectively for 2 years. Diabetes, demographic, and health information was collected at baseline, 1 year, and 2 years. Data on falls were collected at baseline, 4 weeks, and every 17 weeks thereafter. Medical records were abstracted to confirm fall-related morbidity.

    RESULTS—The average age of the study population was 62 years, with 77% male and 23% female. Approximately 32% had fixed foot deformities, 58% had insensate feet, and 76% had comorbid conditions. Of the participants, 252 (64%) reported at least one fall during the 2-year study period. The overall incidence of falls in this cohort was 1.25 falls/person-year (95% CI 1.17–1.33). For the 164 participants (41%) who reported two or more falls, a BMI ≥30 kg/m2, the presence of one or more comorbid conditions, and insensate feet increased the risk. Two or more falls of any type were associated with a higher fracture risk. Although women were not at significantly greater risk for falls than men, their fracture incidence was 3.6 times higher.

    CONCLUSIONS—Falls are very common in individuals with diabetes and prior foot ulcers. A small percentage of falls resulted in fractures. The risk of a fall-related fracture was significantly higher in women than in men. Increased attention to falls and fall prevention is indicated for diabetes care providers.


    • Address correspondence and reprint requests to Carolyn Wallace, PhD, VA Puget Sound Health Care System (152), 1660 S. Columbian Way, Seattle, WA 98108. E-mail: carolyn.wallace{at}

      Received for publication 4 March 2002 and accepted in revised form 2 August 2002.

      The views expressed in this article are those of the authors and do not necessarily represent the views of the agencies that provided financial support.

      A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

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