The World Health Organization defines the diabetic foot as a combination of neuropathy and various degrees of peripheral vasculopathy leading to infection, ulcer formation and/or deep tissue destruction in the lower extremities of diabetic patients. Overseas statistics show that the incidence of lower limb vasculopathy is 22.6%, 23% and 66.7% for those with diabetes for 5 years, 5 to 10 years and more than 10 years respectively; the incidence of diabetes with neurological dysfunction is 30-67%, and the incidence increases gradually with the prolongation of the disease, and the incidence of neuropathy can be as high as 90% for those with the disease for more than 10 years. The incidence of neuropathy can be as high as 90% for those with more than 10 years of disease. The diabetic foot, in terms of formation mechanism, is mainly due to the abnormal changes in the function and structure of the vascular wall caused by the continuous high sugar state of the blood, resulting in ischemic damage to the blood supply area, including the surrounding muscle, bone and nerve tissues, manifesting as muscle atrophy, osteoporosis, joint deformity, abnormal sensation, and even necrosis of the surrounding tissues, such as dry and wet gangrene. The reduction of blood flow naturally affects the defense function of local tissues, and uncontrollable infections are more common; moreover, infections also aggravate the symptoms of diabetic foot. Clinically, foot ulcers have become one of the most common and disabling complications of diabetes, with 12%-25% of diabetic patients developing foot ulcers during their lifetime, and 85% of diabetic patients having their feet amputated because of persistent ulcers. Diabetic foot is clinically divided into 4 stages according to the severity of ischemic symptoms: Stage 1 patients have the mildest condition, feeling only coldness and numbness in the lower extremities and occasional leg cramps. The clinical consultation rate of patients in this stage is not high, and patients often do not pay attention to it or are misdiagnosed, thus delaying the disease; stage 2 patients gradually highlight the symptoms of lower limb ischemia, mostly manifesting as “intermittent claudication”, that is, pain in the lower limbs after walking for a certain distance, and the pain can be relieved after being forced to rest for a while, and can continue walking, and so on. And as the degree of ischemia increases, the walking distance will be gradually shortened until “resting pain” appears – this is the clinical stage 3, which is characterized by persistent pain in the lower limbs at rest, especially obvious at night, and patients often sit on their knees all night, and have difficulty sleeping from the pain. Many patients do not come to the clinic until this stage, missing the best time for treatment and often facing the risk of amputation. At stage 4, the peripheral tissues are severely ischemic for a long time, resulting in blackening, ulceration and necrosis of the limb – commonly known as “old rotten feet”. The “old rotten foot” is stubborn and difficult to heal, and patients often lose confidence in the treatment, and eventually there is only one option – amputation. According to statistics, the amputation rate of diabetic foot is as high as 26.4%, ranking first among non-traumatic amputations. Every 30 seconds, a leg is amputated due to diabetes, and more than half of the amputees need a second amputation within five years. It is the vascular and neurological lesions of the lower extremities caused by diabetes that really need attention – they are the direct culprits affecting the quality of life of patients. Diabetic foot has become a heavy yoke for diabetic patients, both physically and mentally. Diabetic foot – the need for the attention of the whole society The latest survey of the Chinese Diabetes Association shows that the prevalence of diabetes in China has reached as high as 9.7% – that is, there are now nearly 100 million diabetics in China – and China has overtaken India as the number one country with diabetes. According to this projection, there are now at least 40 million diabetic foot patients in China, and this figure will continue to increase year by year. Such a large number reminds us that diabetic foot has become a social problem, and calls for the attention of the whole society can not be delayed. The most basic problem at present is the general lack of proper understanding of diabetic foot, which also includes some doctors. Many patients in the clinic already have symptoms such as cold lower limbs, limp or even foot ulcers that do not heal for a long time, and only when they go to the clinic do they find abnormally high blood sugar; some patients who have been diagnosed with diabetes are not aware of any discomfort, so they are paralyzed and do not control their blood sugar with regular medication, which eventually leads to the occurrence of diabetic foot; some other patients are misdiagnosed with calcium deficiency, arthritis, etc. and receive the wrong treatment plan. And so on. These cases profoundly reflect the indifference of people’s awareness of self-care and the lack of knowledge about diabetic foot. This is also a wake-up call for us – the prevention and treatment of diabetic foot is beyond the scope of hospitals and requires the participation of the whole society. In fact, regular annual checkups can effectively screen out diabetic and diabetic foot patients in a timely manner, followed by active education and guidance to encourage these patients to cooperate with treatment and regular review, which can greatly reduce the occurrence of diabetic foot or delay the development of diabetic foot, and can effectively reduce the rate of amputation. Although in recent years, under the promotion of the new national medical reform policy, a medical security system covering urban and rural areas has been initially established, centering on tertiary hospitals, community hospitals and rural health institutions. However, due to geographical differences and the backwardness of patients’ health concepts, the current medical insurance system has not fully played its proper role. Therefore, it is imperative to increase the education of diabetes knowledge, popularize the correct health concept, and raise people’s awareness and concern about diabetic foot throughout the society. In addition, a major national policy support is needed to narrow the geographical medical level differences. The damage to blood vessels caused by diabetes is extensive and long-lasting, and diabetic foot patients often pay a heavy price for this – both financially and physically and mentally. According to U.S. insurance statistics, the average cost per patient for treatment of a diabetic foot ulcer is $4,595. In the current environment of “difficult and expensive medical care” in China, many patients are forced to delay treatment due to financial pressure, which has contributed to the high amputation rate of diabetic foot to some extent. This also objectively requires government departments to introduce relevant policies as soon as possible to expand the medical insurance coverage of diabetes-related drugs, increase the proportion of medical insurance costs, and improve social welfare. In addition, in addition to the high cost of medical care, the long-term prolongation of the disease and the decline in quality of life is also a great blow to the patient’s body and mind. Some statistics show that 11% of diabetic patients will develop major depression and 31% of diabetic patients will have varying degrees of aggravation of depressive symptoms. Therefore, psychological assistance for diabetic foot patients should also be an essential part of social security, and it is urgent to establish psychological assistance stations for diabetic foot in all regions of the country. Prevention-oriented, step by step Early diagnosis and active intervention is the most effective prevention and treatment strategy for diabetic foot, the root of which is early detection of diabetes and effective glycemic control. Regardless of the period of diabetic foot, effective blood sugar control is the basis of all treatment plans. If the body is chronically hyperglycemic, even if the blood glucose level is later lowered by aggressive treatment, it is still prone to diabetes-related complications, a phenomenon known as the “metabolic memory” effect. This phenomenon is known as the “metabolic memory” effect. Therefore, early and effective blood glucose control is the basis for the earliest prevention of diabetic foot. Once diabetes is diagnosed, one should always be on the alert for the development of diabetic foot. Regular vascular ultrasonography can accurately assess the patency of the vascular lumen and help to detect the diseased vessels at an early stage for timely intervention. Electromyography can understand the peripheral nerve condition and assess whether there is nerve involvement. In addition, ankle-brachial blood pressure ratio determination, single nylon filament assay, microcirculation examination and X-ray examination can help in the early detection of diabetic foot. Patients with a confirmed diabetic foot should undergo further vascular CT or angiography to assess the extent of vascular disease and determine further treatment options. Patients should strengthen foot care at this time because diabetic foot patients are highly susceptible to skin infections, and due to combined neuropathy, the affected limbs are unresponsive to external cold, heat and pain, and their defenses are severely weakened. On the one hand, foot care should pay attention to foot hygiene, trimming nails should not be too short to avoid damage to the nail groove secondary infection, on the other hand, foot trauma should be avoided, choose comfortable shoes and socks, avoid tight shoes and socks on the skin extrusion wear. In addition, preventive foot orthopedic surgery can correct the unbalanced stress in the foot and effectively reduce the occurrence of foot ulcers and major amputations. Comprehensive treatment, “vascular” based Diabetic foot is an interdisciplinary disease, and the management of diabetic foot also requires multidisciplinary collaboration, including endocrinology, dermatology or plastic surgery, orthopedics or orthopedics, vascular surgery, etc., for comprehensive treatment. However, due to insufficient prevalence, patients with diabetic foot are currently concentrated in endocrinology for conservative treatment. Professor Guo Wei pointed out, “Diabetic foot, including neuropathy, is mainly due to tissue ischemia caused by vascular stenosis or occlusion, and solving the problem of lower limb ischemia should be the focus and breakthrough point of clinical treatment – vascular surgery is more specialized in this and has irreplaceable advantages. “ In addition to symptomatic treatment such as hypoglycemia, anti-infection and nerve nutrition, vasodilatation, microcirculation improvement, as well as expectorant and anticoagulant drugs have become the main routine medication for diabetic foot patients in clinical practice. For patients with early diabetic foot, long-term use of aspirin and other drugs to dispel aggregation and anticoagulation can significantly slow down the progress of the disease. Moreover, pharmacological treatment also plays a good supporting effect on the prognosis of surgery or endoluminal treatment. Drug therapy alone cannot fundamentally alter the stenosis or occlusion of the vessel, which requires the use of surgical or endoluminal routes. Traditional surgical approaches include vascular bypass, endovascular stripping patchplasty, etc. For severe stenosis or occlusive lesions of the supraclavicular vessels, traditional surgery still retains its classical features and, despite the high degree of trauma, long-term patency is superior to endoluminal operations. However, the diabetic foot often presents with multiple vascular lesions in both lower extremities, with the tibiofibular artery being the most common. Intraluminal treatment shows a clear technical advantage at this point. The small balloon designed for the tibiofibular artery can reach the dorsalis pedis artery in a smooth flow and complete the dilation of the stenosed artery. The results are immediate, with many patients experiencing a return of skin temperature and improvement in pain immediately after the procedure. It is also safe and has few complications as it can be performed without incision, usually under local anesthesia. Therefore, the endoluminal balloon technique is undoubtedly a good choice for cases where the vasculature is not completely occluded and the anatomical pathway allows. In addition, the introduction of some new endoluminal devices, such as Outback and plaque spinning device, provides the possibility of endoluminal management of arterial occlusive lesions and extends the scope of application of endoluminal techniques for the management of diabetic lower limb vascular lesions. Professor Guo Wei said that the future vascular treatment technology will develop in the direction of minimally invasive, painless, safe and efficient, and intracavitary operation will undoubtedly become the mainstream technology. The clinical effects of hyperbaric oxygen and stem cell transplantation for the treatment of diabetic foot have also been confirmed to some extent in recent years. Especially worth mentioning is the stem cell transplantation technique, which can significantly reduce the pain symptoms of patients by mobilizing stem cells from bone marrow and injecting them into the ischemic tissue of the affected limb. Although the mechanism of this method is still unclear, the clinical effect is quite attractive, and it may become a new direction and breakthrough point for the treatment of diabetic foot in the future.