Distribution of the initial site of infection in diabetic foot and associated initiating etiologies

Background: Diabetic foot is a very common condition responsible for a major bulk of surgical admissions and out-patient visits. Lack of awareness of many factors influencing the incidence of this disease complex has led to loss of life, limb and quality of life. The site-specific incidence of initial site and initiating factor has not been studied in diabetic foot.Methods: A study has been done over a period of one and a half years which looked into the distribution of initial site of infection in diabetic foot and associated initiating etiologies. The study was cross sectional. History, general inspection of foot, dermatological, neuropathic and vascular assessments were done, in addition to making careful notes about the site and cause of infection.Results:60.7% of patients were >60 years old, 55.3% were male patients. 63.3% of patients had diabetes for more than 10 years. In 29.3% the initial site of infection was the big toe, 22% in the ball of foot, 18% in the other 4 toes together, 14.7% in the interdigital spaces, 10.7% in the heel and 5.3% in the mid foot. In most of the cases the etiology is multifactorial, trauma in 56%, musculoskeletal deformities in 47.3%, callosities in 41.3%, cracks and fissures in 16.7%, fungal infection in 7.3%, nail infection in 6%, no initiating introduction of infection identified in 10.7%.Conclusions: Awareness of and thus particular stress being place on identification of specific site and cause of infection should help in care of the foot in diabetics.