Introduction: Diabetes foot deformity is among the major causes of diabetic foot ulceration that results in lower limb amputation. But, the study on the distribution of foot deformity and its risk factors among diabetic patients in Ethiopia is not satisfactory; particularly there is no study in the study area. Objective: To assess the prevalence and associated factors of foot deformity among adult diabetic patients on follow-up at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia, 2022 Methods: A hospital-based cross-sectional study was conducted among 392 diabetic patients at Debre Markos Comprehensive Specialized Hospital from June 1st to July 30th, 2022, using a systematic random sampling technique. Data were collected by using pre-tested semi-structured questionnaires and diabetic foot assessment format, entered through epidata 4.6 versions, and exported to STATA 14 version for analysis. Multivariable binary logistic regression was used to determine the association between dependent and independent variables. Adjusted odds ratios (AOR) with their 95% Confidence interval (CL) were used to determine the strength of the association, and a variable with a p-value <0.05 were statistically significant in multivariable logistic regression. Result: The overall prevalence of foot deformity was 33.42% [95% CI: 28.9–38.3]. In the final multivariable binary logistic regression analysis, rural residency [AOR = 2.55, 95% CI: 1.26, 5.14], poor glycemic control [AOR = 2.63; 95% CI: 1.45, 4.79], diabetes duration between 11 and 15 years [AOR = 2.42; 95% CI: 1.12, 5.26], diabetes duration greater than 15 years [AOR = 4.62; 95% CI: 1.80, 11.82], inadequate footwear[AOR = 2.06; 95% CI: 1.13, 3.75] and presence of peripheral neuropathy [AOR = 8.11; 95% CI: 4.45, 14.77] were statistically significant associated factors with diabetes foot deformity. Conclusion: The prevalence of foot deformity among adult diabetic patients was high. It is recommended to incorporate foot deformity screening in routine diabetic foot management.