I. What is diabetic foot? A: Diabetic patients often suffer from long-term disorders of blood glucose and lipid metabolism, which can easily lead to damage of vascular endothelial cells and basement membrane, resulting in diabetic vascular complications. Patients with combined neuropathy and varying degrees of vasculopathy leading to lower limb infection, ulcer formation and/or deep tissue destruction are called diabetic foot. It is highly disabling and lethal, with a high amputation rate of more than 20%, often ending in amputation and death. Diabetic foot occurs in patients with poor blood sugar control mostly between 5 and 10 years. Therefore, prevention of foot complications in diabetic patients is the key to improving their quality of life. Qu Xintao, Department of Orthopedics, General Hospital of Jinan Military Region II. What is the harm of diabetic foot? A: The danger of diabetic foot disease is briefly summarized as “diabetic foot three high”: 1, high mortality: due to the amputation surgery trauma, and the quality of life after the amputation is significantly reduced, resulting in physical and mental damage to the patient, so the mortality rate of patients after surgery is very high: the mortality rate within 6 months is 20%, and the mortality rate 5 years after amputation is even as high as 50%-70%. 2, high morbidity: the morbidity rate is high: the morbidity rate is high. 2, high morbidity: according to epidemiological surveys: diabetic patients with the development of the disease, eventually 30% of patients with complications of foot disease, and the incidence is higher in elderly patients over 65 years of age. 3, high amputation rate: diabetic foot hazards include diabetic patients prone to vascular stenosis or occlusion, resulting in insufficient blood supply to the tissue, often developing toe ulceration, infection or necrosis, and soon spread to the healthy foot tissue, infringing on the This often leads to toe ulceration, infection or necrosis, which can quickly spread to healthy foot tissue, invade bone and eventually lead to amputation. The disease causes nearly 120,000 amputations each year in Europe, with an amputation rate of 33%. According to statistics, 70% of the world’s amputations are performed on diabetic patients, and diabetics are 25 times more likely to “lose their legs” than non-diabetics, and more graphically, one leg is amputated every 30 seconds because of diabetes. Third, who are classified as high-risk diabetic foot patients? A: They are roughly divided into the following six categories of patients1 Diabetic patients with severe cerebrovascular disease: Patients with cerebrovascular lesions often have imbalance in limb muscle strength and unfavorable limb movement. This leads to foot deformation and abnormally high local pressure, causing ulcers.2 Diabetic patients with long-term swelling of the foot due to cardiac and renal insufficiency: human tissues under swelling, the volume of the foot becomes larger, the skin becomes thinner, the brittleness of the subcutaneous tissue increases, and wearing shoes for daily activities can lead to skin damage and cause ulcers.3 Diabetic patients with deformities of the foot and hypertrophic corpus callosum on the sole or edge of the foot: all of the above factors can Diabetic patients with abnormally high local pressure in the foot and lower pressure resistance in the soft tissues of the foot than normal people can easily cause ulcers.4 Diabetic patients who smoke for a long time: nicotine and carbon monoxide contained in cigarette smoke can directly cause damage to the blood vessel wall and are closely related to the risk factors for atherosclerosis, such as hypercoagulable blood, high blood lipids and high blood pressure. The damage to the microvasculature caused by smoking is also associated with the involvement of harmful substances in the smoke in these processes. Accelerated neurological and vascular lesions in diabetic patients make ulcers easy to occur and difficult to heal.5 Diabetic patients who live alone for a long time and have poor economic status: such patients neglect foot health due to unattended or poor economic situation, and once ulcers occur, they often lead to amputation or fatal consequences.6 Diabetic patients who have been diagnosed with lower limb neurological and vascular lesions of moderate degree or higher by regular hospital examination:1 Diabetes-induced Peripheral neuropathy: such as numbness, walking sensation like stepping on cotton, or a pins and needles sensation arising from abnormal sensation in the ends of the limbs, especially the feet.2 Diabetes-induced lower limb vasculopathy: in the early stage, it manifests as intermittent claudication, such as numbness, pain, and shorter and shorter walking distance in the lower limbs. Or the patient feels pain, even when sitting still, etc. Fourth, how to prevent the occurrence of diabetic foot? A: Therefore, among the tertiary prevention strategies for diabetes, preventing the occurrence of diabetic complications is the most critical and important. Blood sugar control is one of the basic measures to prevent diabetic foot disease, blood pressure control and smoking cessation as well as attention to foot cleanliness, choice of shoes and socks, foot problem care methods (nail trimming, corns and calluses, fungal infections, foot injuries) are all issues that must be paid attention to. For diabetic patients, it is important to develop good foot care habits, especially for patients with long duration of diabetes and dull foot sensation should check their feet daily, wear appropriate shoes and socks, see if there are foreign objects in the shoes before wearing them, test the water temperature by hand before washing the feet to prevent burns, prohibit direct contact of the feet with heating devices such as electric blankets and electric heaters, prohibit barefoot walking, see a doctor regularly, conduct foot examinations and Once you find a foot ulcer or foot pain, you should go to the hospital in time. V. How to treat diabetic foot patients? A: The treatment of diabetic foot requires the collaboration of medical and surgical departments and the adoption of comprehensive treatment methods. (1) Comprehensive treatment needs to be carried out throughout the whole treatment process, and the relationship between the whole and the local should be handled correctly. 3. anti-infection; 4. supportive treatment. (2) Anti-infection; use the principle of sensitive, broad-spectrum, adequate amount and combination of two or more antibiotics; (3) Correction of acute and chronic complications: such as ketoacidosis, hypoproteinemia, etc.; actively improve cardiac and renal function and control hypertension. (4) Improvement of microcirculation: through vasodilatation, anticoagulation, fibrinogenesis, platelet antagonists, such as ACEI, salvia, prostaglandin E, safflower injection, etc. (5) Neurotrophic agents: vitamin B6, vitamin B12, ATP, coenzyme A, ganglioside, etc. (3) Treatment of diabetic foot (1) Foot infection: apply antibiotics to control infection. (2) Neural foot ulcers: 1. apply pressure-altering orthopedic shoes or foot orthoses to change the local pressure of the patient’s foot; 2. change medication regularly after debridement; 3. use some biological agents or growth factor substances to treat incurable foot ulcers; 4. aldose reductase inhibitors. (3) Local wound treatment: incision and drainage, debridement and drug exchange (4) Surgical treatment: such as vascular replacement, angioplasty or vascular bypass surgery, surgical revascularization (arterial bypass), interventional radiology, amputation is considered only for patients with diabetic gangrene who have pain at rest and extensive lesions that cannot be surgically improved. A journey of a thousand miles begins with the foot. It is a long way to go for foot examinations and attention to foot health. May every diabetic patient have a healthy pair of feet.