The company’s main business is to provide a wide range of products and services to its customers. One day while walking, the bottom of his foot was accidentally stabbed by an iron nail, and he found a nearby clinic for a simple bandage and ate anti-inflammatory drugs, but it did not heal at all. Later, the patient came to the Department of Endocrinology and Metabolism of Southern Hospital. After consultation and research of several experts, the patient was finally treated with negative pressure suction, ultrasonic debridement and configuration of dressing, etc. After half a month, the large ulcer was fortunately healed and the pain of amputation was avoided. “It was just a small nail, how could I have known it would be so serious?” Now whenever he talks about his foot, in addition to his gratitude to Southern Hospital, Master Li will always make such a sentiment! ”Most diabetic patients don’t know enough about this complication of diabetic foot, and they don’t go to the hospital until their feet are already seriously ulcerated or even facing amputation, and as a result, they miss the best treatment time.” Xue Yaoming, director of the Department of Endocrinology and Metabolism, said, “There are about 40 million diabetic patients in China, and the incidence rate in central cities has exceeded 10 percent. Five to 20 percent of these patients will develop foot ulcers or gangrene during the course of their disease. The amputation rate of diabetic foot disease is 15 times higher than that of non-diabetic patients, and about 50% of the annual amputations are diabetic patients, with someone losing a leg every 30 seconds due to diabetic foot.” Small wounds often turn into big problems: “The triggering factors of diabetic foot are skin damage, trauma or burns, infection, etc. Most of them are only very small wounds when they start, and early treatment can make the trauma effectively controlled. As most patients often fail to take appropriate treatment measures, thus many diabetic foot patients face the end of ulcer expansion and even amputation. The gentleman above is a typical clinical example.” There are also some wounds caused by arterial occlusion, although the progress is slow, but the treatment is very tricky, if not timely examination and treatment, the lesion site will gradually blackened necrosis, “once the formation of ischemic gangrene, amputation is often difficult to avoid.” Comprehensive treatment, internal and external combination: “There is no diabetes naturally there is no diabetic foot, comprehensive treatment, internal and external combination to achieve satisfactory results, many hospitals have a fine division of labor between internal and surgical departments, which results in internal medicine only regulates, surgery only treats the wound, if the patient’s trauma is relatively large, may end up amputating the limb to go.” Xue Yaoming said that for a systemic project like dealing with diabetic foot, the combination of local and overall must be emphasized. Once a diabetic patient has a local wound in the foot, it is never like a simple normal human wound, but a local manifestation of a systemic lesion. If too much emphasis is placed on treating the local wound and being led by the nose by the good or bad of the wound, then it will never be cured. On the whole, the first thing is to control high blood sugar. The occurrence of foot infection will lead to increased difficulty in blood sugar control, and most of them need insulin. Control of blood pressure, lipids, smoking and other variables can play a more positive role in wound healing. In addition, swelling in the lower extremities must be reduced and nutritional status must be improved to the best of one’s ability. ”Ninety percent of neuropathic foot ulcers can be healed with conservative treatment.” The key to managing neuropathic foot ulcers is to reduce the pressure caused by the primary lesion, which can be achieved by changing the patient’s foot pressure with special pressure-altering orthopedic shoes or foot orthoses. The number of dressing changes and topical medications is determined by the depth of the ulcer, its size, the amount of exudate, and whether it is co-infected. For the general clinician, it is important to be able to identify the characteristics of different foot ulcers due to different causes, e.g., neuro-ischemic ulcers usually do not have a lot of exudation and therefore very absorbent dressings should not be used; if there is a combination of infection and more exudation, the wrong choice of dressing can make the wound macerate and worsen the condition, causing serious consequences. For foot ulcers that are difficult to heal, some biological agents or growth factor-like substances, such as platelet-derived growth factor (PDGF) and epidermal growth factor (EGF), can be used to treat neuropathic foot ulcers, with their ability to promote ulcer healing. ”Reconstructive vascular surgery may be considered for ulcers associated with severe lower limb ischemia,” Xue said, adding that vascular replacement, angioplasty or vascular bypass may allow some patients to avoid amputation. Those who have developed gangrene and have pain at rest and extensive lesions that are inoperable are given an effective amputation, below the knee if possible. An angiogram is advisable before amputation to determine the plane of amputation. For those whose vascular obstruction is not very severe or for whom surgery is not indicated, conservative medical treatment with intravenous vasodilators and circulation-improving drugs such as kaiser and trimethoprim and oral aspirin may be indicated. Some small gangrene at the toe end will occasionally fall off on its own after infection control. Patients after amputation surgery should be given rehabilitation treatment, and they should be helped to resume walking as soon as possible using a prosthesis. Since there is a high possibility of ulceration or gangrene on the other side after amputation on one side, it is important to enhance education about foot protection for patients. Infection is the main cause of lesion enlargement, especially in those with osteomyelitis and deep abscesses, which often require hospitalization. In such cases, intensive insulin therapy based on blood glucose monitoring should be provided to bring blood glucose to or near normal, along with intensive anti-inflammatory and aggressive debridement. The management of superficial tissue infection is different from that of deep tissue infection. In principle, the decision on medication should be based on bacterial culture. Sometimes, the infection is due to rare and atypical bacteria, and local debridement should be considered along with early administration of effective antibacterial therapy. For superficial infections, oral broad-spectrum antimicrobials, such as cephalexin plus clindamycin, can be used. Cephalexin or quinolones alone should not be used because the antimicrobial spectrum of these drugs does not include anaerobes and some G+ bacteria. Clindamycin can enter tissues well, including bone tissue which is difficult to penetrate, and oral therapy can be continued for several weeks. Deep infections can be treated with the same antimicrobials as described above, but should be administered intravenously initially, followed by oral maintenance dosing for several weeks (up to 12 weeks). On a clinical basis, combined with X-rays to understand the effectiveness of treatment, deep infections may require surgical drainage, including removal of infected bone tissue and amputation. “Most disabling limbs are due to the lack of effective treatment as described above.” Early Screening Early Prevention: “The diabetic foot is preventable and treatable!” Such amputations can be avoided or delayed by enhancing preventive protection of the foot with risk factors, and early screening is important to diagnose and prevent diabetic foot, says Xue Yaoming. High risk factors for the development of foot ulcers in diabetes include peripheral and vegetative neuropathy, peripheral vascular disease, previous history of foot ulcers, foot deformities (e.g., Eagle Claw Foot, Charcot Foot), callus, blindness or severely diminished vision, combined renal pathology especially renal failure, elderly people living independently, those with a lack of knowledge about diabetes and those who cannot be protected effectively. Regular early diabetic foot screening for diabetic patients is important to prevent the occurrence of foot ulcers and amputations. The 10g nylon wire examination method, 40g nociception measurement, vibration measurement, skin temperature measurement, and sweat secretion function test can detect early whether diabetic patients already have protective foot nerve function deficiency. The ankle artery, brachial artery blood pressure ratio (ABI) is a very valuable indicator of blood pressure and vascular status of the lower extremity, with a normal value of 1.0-1.4, <0.9 for mild ischemia, 0.5-0.7 for moderate ischemia, and <0.5 for severe ischemia, and patients with severe ischemia are prone to lower extremity (toe) gangrene. These tests are non-invasive and can get results quickly, which is very useful for early detection of lesions. "Love your feet as much as you love your eyes!" Director Xue Yaoming offers this advice to diabetic patients. "Once you are diagnosed with diabetes, you should start preventing ulcers and amputations, and you should go to the hospital once a year for a foot health check, or quarterly if you have complications, especially for patients who have had foot ulcers and had amputations due to diabetes, once every 1 to 3 months. Usually, you should maintain a healthy lifestyle, actively control your blood sugar, and strengthen the care of your feet, starting with the details and little things in life, including daily foot washing, nail clipping, shoe selection, sock selection, and so on. Once the lower limb discomfort occurs, do not miss the treatment."