Gangrenous lesions of the foot in the diabetic patient may be classified into three groups,1 clinical differentiation among which is important in prognosis: (a) Gangrene due to arterial insufficiency with minimal or no associated infection. This type is almost always acral in distribution and "dry" in appearance. (b) Gangrene of local nature, secondary to the destructive action of infection. The association of this form of necrosis with diabetes mellitus is frequent. (c) Gangrene of combined etiology, with elements of vascular impairment and infection intermixed, a group most difficult to evaluate.
Emphasis will be given in this report to instances of gangrene secondary mainly to infection or to infection combined with varying degrees of major arterial disease. Such "septic necrosis" can occur at any of the following sites in the foot and usually follows relatively minor trauma to the skin.
(1) In the toes, about the nails, or in relation