One day in April 2007, I saw a patient from Jilin, Northeast China. When I examined him, I found that his feet were wrapped in yellow-green pus-soaked gauze, and people were shocked when I opened them. It turned out that during the New Year period in February 2007, this patient went to the countryside to visit relatives and kept stepping on the fire bed while drinking, and no abnormality appeared at that time. He came to Beijing as a last resort to save his feet, although he was able to save them after a lot of hardships. However, his experience has taught us a painful lesson: the protection of painless feet should never be relaxed. The lesion of painless foot is based on diabetic neuropathy, which causes the weakening or loss of protective sensation at the end of the limb. The neuropathy of diabetic lower limbs includes sensory neuropathy, motor neuropathy and autonomic neuropathy, with sensory neuropathy being more common in clinical practice. Most patients have numbness, ankylosis and pain in the lower extremities, and the pain is generally mild and tolerable, while a few have more severe pain that affects daily work and sleep. For patients with diabetic foot ulcers, the harm of no sensation or dull sensation is much more serious than having abnormal sensation such as numbness or pain. For painless feet, treatment is mainly for primary diabetes and neuropathy, including blood sugar control, nerve nutrition, etc., but early detection and timely diagnosis and treatment are the most critical. Prevention is especially important than treatment. Early detection According to statistics, 70% of diabetic patients with more than 10 years of disease have a combination of diabetic neuropathy. For diabetic patients, it is important to detect the combination of neuropathy in a timely manner. Fortunately, the medical community is now highly aware of this issue, and various screening and education programs for diabetic complications have been launched in many hospitals. Neuropathy is examined by measuring temperature, pain, vibration and nerve conduction velocity. Nylon wire examination is an internationally accepted method of evaluating foot sensation, in which nylon wires of different diameters are used to apply pressure to the foot to determine whether there is sensation at the site of contact. Patients who do not feel the 10 g nylon wire pressure should be considered to have protective sensory loss and receive the necessary prophylactic treatment in a timely manner. Timely diagnosis and treatment The painless foot, because of its loss of pain sensation, puts the patient at risk in 2 ways: (1) lack of sensitivity to self-protection against various injury factors. Under normal circumstances, when the body is exposed to various traumatic factors (including scalding, freezing, cutting, etc.), it tends to avoid these injury-causing factors in time out of self-protective instincts. Patients with painless feet obviously lack sensitivity to the above-mentioned injury-causing factors, resulting in a state of unconsciousness even after serious injuries have been caused; (2) lack of perception of some formed injuries, resulting in some minor injuries not being treated in time and gradually aggravated, and finally having to amputate the limb, which is how neuropathic ulcers occur. This is especially common in patients with recurrent and prolonged diabetic foot ulcers. In some diabetic foot ulcers, the appearance of the ulcer is far from the reality of the deeper part of the wound. The ulcer may seem small on the surface, but in fact it is very deep and the infection spreads up and down the fascial compartment until eventually the whole foot is infected or even the whole body. Unfortunately, during the aggravation, the patient is unaware of the aggravation of the injury because of the inability to perceive pain. In this sense, the examination of diabetic foot ulcers should be done “strictly and quickly”. Even if there is a minor injury, patients and their families should not treat it casually, but should promptly seek medical examination, because it may be too late by the time you feel it is more serious. Prevention is better than cure The prevention of pain-free foot is mainly about the prevention of injury factors, specifically avoiding all possible foot injuries and avoiding them in time before they are caused. Here are some practical suggestions: ① check your feet daily to know whether there is potential damage; ② don’t walk barefoot at any time to avoid letting your feet get cold; ③ keep your feet away from hot things like warm water bags and radiators, and test the water temperature with your elbow first when washing your feet; ④ don’t apply all kinds of damaging chemicals on your feet; ⑤ trim your toenails to avoid damaging the skin and nail bed; ⑥ check for foreign bodies and abnormal protrusions before wearing shoes; ⑦ pay attention to the prevention of foot fungus, and don’t damage the skin or nail bed. ⑦ Pay attention to the prevention of foot odor and do not scratch your feet casually. In short, treating painless feet is like treating a 1-year-old child, they need extra care because of their ignorance of the dangers of the outside world, do not “one mistake and a thousand hates”.