Gangrene localized to the feet in diabetic patients

A consecutive series of 189 diabetic patients with manifest gangrenous lesions localized to the feet were studied. These patients had 293 gangrenous lesions localized to 5 different areas: toes 58%, interdigital spaces 6%, dorsa of the feet 10%, metatarsal heads 10% and heels 16%. Cardiac decompensation with edema and edema from other causes were the dominant precipitating factors for the gangrenous lesions. Arterial insufficiency alone or together with other precipitating factors was seen considerably less often. Gangrenous lesions localized to the toes were especially common in patients with long duration of diabetes and in men. In women gangrenous lesions localized to the interdigital spaces and to the heels were more common. Multiple gangrenous lesions were more common in patients with cardiac decompensation, while the occurrence of only one lesion was especially common in patients with signs of arterial insufficiency and in men.