High prevalence of foot diseases in Europe: results of the Achilles Project

Objective. To provide an insight into the prevalence of foot disease in Europe, and to include an assessment of the prevalence of predisposing factors and their correlation with foot disease. Design. Large population-based survey conducted in 16 European countries. Setting. The project consisted of two parts (study I and study II), in which all patients presenting to general practitioners and dermatologists over a defined time period were invited to participate. Patients. In study I, 70 497 patients presenting to dermatologists or general practitioners were recruited, and in study II 19 588 patients presenting to dermatologists were recruited. Main outcome measure. The feet of all participants were examined for signs of foot disease. The assessors also recorded relevant details such as the age and sex of patients, and the presence of predisposing factors for foot disease. In addition, patients in study II were offered a free mycological examination of the toenails and skin on the feet. Results. In study I, 57.0% of patients had at least one foot disease. In study II, 61.3% had at least one foot disease. The proportions of patients with fungal foot disease and non-fungal foot disease in study I were 34.9% and 38.4%, respectively, and in study II were 40.6% and 41.7%, respectively. Orthopedic conditions and metatarsal corns were the most frequently reported non-fungal foot diseases, and onychomycosis and tinea pedis were the most frequently observed fungal infections. Conclusions. This large-scale survey suggests that the prevalence of fungal and non-fungal foot disease is higher than previously estimated.