{
  "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).\n\nMethods: 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.\n\nResults: 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).\n\nConclusions: 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.",
  "abstract_shown": true,
  "affiliations": [
    "Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University",
    "Department of Endocrinology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences",
    "Department of Peripheral Vascular Disease, Pingdingshan Traditional Chinese Medicine Hospital",
    "Department of Wound Repair Surgery, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology",
    "Department of Endocrinology, Jilin Province People’s Hospital",
    "Department of Endocrinology, Air Force Hospital of Northern Theater Command of PLA",
    "Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University",
    "National Clinical Research Center for Geriatric Diseases, Xiangya Hospital of Central South University",
    "Department of Endocrinology, Mudanjiang Cardiovascular Hospital",
    "Department of Endocrinology and Foot & Ankle Surgery, Yantai Yuhuangding Hospital, Qingdao University",
    "Department of Endocrinology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University",
    "Department of Endocrinology, Kailuan General Hospital Affiliated to North China University of Science and Technology",
    "Department of Endocrinology and Metabolism, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University",
    "Department of Diabetic Foot, NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University",
    "Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University",
    "Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University",
    "Department of Endocrinology, The Ninth Medical Center, Chinese PLA General Hospital",
    "Department of Tissue Repair and Regeneration, Chinese PLA General Hospital",
    "Department of Endocrinology and Metabolism, Innovation Center for Wound Repair, Diabetic Foot Care Center, West China Hospital, Sichuan University"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 20,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yingzhou Shi"
    },
    {
      "affs": [
        1
      ],
      "name": "Tao Xue"
    },
    {
      "affs": [
        2
      ],
      "name": "Liren Ma"
    },
    {
      "affs": [
        3
      ],
      "name": "Lijun Zou"
    },
    {
      "affs": [
        4
      ],
      "name": "Kexin Li"
    },
    {
      "affs": [
        5
      ],
      "name": "Yanxiang Wu"
    },
    {
      "affs": [
        6,
        7
      ],
      "name": "Qiuhong Zhou"
    },
    {
      "affs": [
        8
      ],
      "name": "Yanmei Yu"
    },
    {
      "affs": [
        9
      ],
      "name": "Xiaorui Jiang"
    },
    {
      "affs": [
        10
      ],
      "name": "Lin Li"
    },
    {
      "affs": [
        11
      ],
      "name": "Jingyi Zhang"
    },
    {
      "affs": [
        12
      ],
      "name": "Huifeng Zhang"
    },
    {
      "affs": [
        13
      ],
      "name": "Penghua Wang"
    },
    {
      "affs": [
        14
      ],
      "name": "Bingquan Yang"
    },
    {
      "affs": [
        15
      ],
      "name": "Hong Zhu"
    },
    {
      "affs": [
        16
      ],
      "name": "Aihong Wang"
    },
    {
      "affs": [
        17
      ],
      "name": "Yufeng Jiang"
    },
    {
      "affs": [
        16
      ],
      "name": "Zhangrong Xu"
    },
    {
      "affs": [
        18
      ],
      "name": "Xingwu Ran"
    },
    {
      "affs": [
        0
      ],
      "name": "Qiu Li"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4kg2cpcw57y01.bib",
  "cited_by": 0,
  "doi": "10.3389/fendo.2026.1983798",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13730970/",
  "id": "4kg2cpcw57y01",
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  "landing_url": "https://www.frontiersin.org/articles/10.3389/fendo.2026.1983798/full",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
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      "2712|Diabetic Foot Ulcer Assessment and Management"
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  "pdf_url": "https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2026.1983798/pdf",
  "pmcid": "PMC13730970",
  "pmid": "42984519",
  "published": "2026-10-21",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/4kg2cpcw57y01.ris",
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    {
      "first_seen": "2026-10-30T12:20:20Z",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2712|Diabetic Foot Ulcer Assessment and Management",
      "subfield": "endocrinology-metabolism"
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  ],
  "title": "Distribution characteristics of initial lesion sites for diabetic foot ulcers in China: a national multicenter survey",
  "title_text": "Distribution characteristics of initial lesion sites for diabetic foot ulcers in China: a national multicenter survey",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T12:21:15Z",
  "url": "https://research.draconitic.com/paper/4kg2cpcw57y01",
  "venue": "Frontiers in Endocrinology",
  "versions": []
}