Different Foot Structural Changes Pattern Between Diabetic and not Diabetic Patients After Weight Loss Due to Bariatric Surgery in Severe Obesity

Aim

To compare the modifications in foot structure and shape in obese patients with or without type 2 diabetes mellitus (T2DM) after weight loss.

Methods

We studied all patients submitted to bariatric surgery in our Department between January and March 2019 with body mass index (BMI) between 40 and 48 kg/m2 before and after the weight loss, dividing them into two groups according to presence (Group 1) or absence (Group 2) of T2DM. We compared changes in: skin temperature at first and fifth metatarsal joint (MJ), ultrasound skin, subcutaneous and fascia thickness, dorsal and ankle circumferences.

Results

We enrolled 46 patients: 19 in Group 1 (M/F 11/8; mean age 48.2 ± 10.3 yrs) and 27 in Group 2 (M/F 10/17, mean age 46.8 ± 10.0). Time requested for expected weight loss was longer in Group 1 (461.5 ± 131.3 days vs 334.2 ± 106.4, P = .0011). Foot and leg dimensions were decreased in both groups, but reduction was greater in Group 2. Also the reduction of skin temperature was greater in Group 2 both at first and at fifth MJ (P = .03 and .02). On the contrary ultrasound skin and subcutaneous thickness reduction was significantly greater in Group 1 both dorsally (P = .009) and plantarly (P < .05) as well as fascia thickness (P = .02).

Conclusions

Our data confirm structural body changes induced by weight loss in severely obese patients, with different patterns in patients affected or not from T2DM: a more important decrease in tissue thickness in the former and a greater volume reduction in the latter, probably related to different oedema resorption.

Level of evidence: Clinical research.