Digital echoes of disease: Infodemiological analysis of diabetic foot search behavior in Ecuador

Background Diabetic foot disease (DFD) is a severe complication of diabetes with high morbidity. Ecuador has significant diabetes prevalence, yet epidemiological data on DFD remains scarce. Infodemiology, using search query data, offers a novel approach to gauge public health interest where conventional surveillance is limited. This study aimed to characterize online search behavior for DFD in Ecuador and its global context. Methods A longitudinal, descriptive infodemiological study was conducted using Google Trends Search Volume Index (SVI) data from January 2015 to July 2025. We analyzed monthly SVI for "diabetic foot" in Ecuador, global trends, and comparative interest across five non-communicable diseases (NCDs). Related top and rising search queries were examined. Statistical analysis included descriptive statistics, time-series comparison, and Spearman's correlation. Results Ecuadorian SVI for DFD showed a volatile upward trend (ρ = 0.6503, p < 0.001), peaking at 100 in February 2023, frequently exceeding global values. Globally, Latin American nations exhibited the highest search interest, with Ecuador ranking 8th (SVI = 64). However, comparative national analysis revealed DFD search interest (mean = 2.18 SD = 0.13) was an order of magnitude lower than for cancer or hypertension. Query analysis showed predominant use of basic Spanish terminology ("pie diabetico", SVI = 100), alongside searches for symptoms, treatment, and clinical classifications, but also frequent misspellings. Conclusion Despite a high diabetes burden, Ecuador demonstrates disproportionately low public digital engagement with DFD information compared to other NCDs, suggesting significant awareness gaps. The alignment with global trends and specific query patterns indicates a maturing but incomplete public understanding of DFD severity. These findings underscore the utility of infodemiology in resource-limited settings and highlight an urgent need for targeted, literacy-appropriate health communication strategies to improve DFD awareness and prevention in Ecuador.