Distribution characteristics of initial lesion sites for diabetic foot ulcers in China: a national multicenter survey
Year: 2026
Type: article
Study design: Observational Study
Abstract: Aims: Systematic data on initial diabetic foot ulcer (DFU) locations in China remain limited. We investigated the distribution of initial DFU sites and precipitating factors, together with secondary associations of recorded anatomical site involvement with diabetic peripheral neuropathy (DPN) and lower extremity arterial disease (LEAD). Methods: This multicenter cross-sectional analysis used an analytical database containing 3,105 records from 2,892 patients recruited at 77 Chinese hospitals (October 2020-April 2022). The earliest dated record was selected for each patient. Physicians recorded, using a 56-region foot classification, the sites where the ulcer first appeared (7,813 site entries from 2,892 patients). Secondary patient-level associations were estimated using age- and sex-adjusted logistic regression with hospital-cluster-robust standard errors. Results: Among 2,892 patients, the most frequent initial-site categories were between toes (1,102/2,892, 38.1%), dorsum of toe (883/2,892, 30.5%), and toe tip (770/2,892, 26.6%). In secondary analyses, right-foot sole involvement was more frequent than left-foot involvement (5.91% vs 4.32%; FDR-adjusted q=0.034), whereas right-foot toe-tip involvement was less frequent (11.89% vs 14.80%; q=0.022). Leading precipitating factors were accidental injuries (32.2%), footwear-related injury (25.4%), and unidentified causes (16.0%). LEAD alone was associated with dorsal-toe involvement (OR = 1.71, 95% CI 1.30-2.24; q=0.002), while DPN alone was associated with heel involvement (OR = 1.83, 95% CI 1.22-2.76; q=0.015). Conclusions: This multicenter cross-sectional study characterizes the distribution of initial DFU sites and precipitating factors in China and identifies secondary site-specific neurovascular associations that may inform targeted prevention.
Source: Frontiers in Endocrinology
Institutions: Shandong Provincial Hospital, Shandong First Medical University, Jiading District Central Hospital, Shanghai University of Medicine and Health Sciences, Huazhong University of Science and Technology, People 's Hospital of Jilin Province, Xiangya Hospital Central South University, Mudanjiang Medical University, Qingdao University, Yuhuangding Hospital, Sir Run Run Shaw Hospital, Zhejiang University, North China University of Science and Technology, Kailuan General Hospital, Henan Provincial People's Hospital, Tianjin Medical University, Southeast University, Zhongda Hospital Southeast University, Southeast University, First Affiliated Hospital of Wenzhou Medical University, Chinese PLA General Hospital, Sichuan University, West China Hospital of Sichuan University
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223137254