Foot Injuries Among Hajj Pilgrims with and Without Diabetes Mellitus: Implications for Infection Management.

Pilgrims attending Hajj in Makkah are at high risk of suffering from trauma and foot injury as they are required to make circuits barefooted on scorching marbles around the Holy Mosque, and march between two hillocks for hours. No study has systematically described the pattern of foot wounds among them. This observational study aimed to determine the spectrum of foot injuries among diabetic and non-diabetic Hajj pilgrims and the preventive measures adopted by them. Pilgrims who attended the Hajj 2013 and sought medical care for foot wounds at mobile podiatric clinics in Mina during the peak days of Hajj were invited to participate in the study and fill out a questionnaire while they were serviced. Podiatric carers noted down the significant signs of foot injuries. Out of 197 pilgrims from 21 different countries who participated in this study, 60 (31%) were diabetic. The two most common injuries observed were blisters (34%) and erythema (25%). Both diabetic and non-diabetic Hajj pilgrims were at high risk of developing infectious wounds, however a significantly higher proportion of diabetic pilgrims had callosities. Use of appropriately fitting protective footwear, and regularity in diets and drugs are highly recommended for pilgrims' optimum foot care. Tailored educational advice on foot hygiene before and during travel could be beneficial for Hajj pilgrims.