Why have a pair of feet become the “life-and-death line” for diabetic patients?
According to the data from the International Diabetes Federation (IDF) in 2025, there are already 537 million diabetes patients worldwide, among whom approximately 15% will develop Diabetic Foot during the course of the disease. This complication may seem like just a “foot problem”, but it can lead to infection, amputation and even death – every 20 seconds, one person has to have an amputation due to diabetic foot worldwide, and the five-year survival rate after amputation is less than 50%, which is lower than that of some cancers. Diabetic foot does not occur suddenly but is the result of the combined effects of neuropathy, vascular disease and infection. This article will provide scientific guidance for diabetic patients and their families from four dimensions: etiology, early identification, treatment and prevention, making “foot care” an important part of the daily management of diabetic patients.
I. The “Triple Threat” of Diabetic Foot: A vicious cycle of nerves, blood vessels and infections
1. Neuropathy: Loss of “perception” in the feet
Long-term hyperglycemia can damage peripheral nerves, leading to the “three main signs of sensory decline” :
Loss of pain perception: Unable to perceive sharp objects, burns and other injuries, prone to hidden trauma;
Abnormal temperature perception: Insensitive to cold and heat, and the injury may be aggravated by scalding from a hot water bag or getting cold barefoot.
Proprioceptive disorder: Decreased muscle coordination in the foot, abnormal pressure distribution during walking, arch collapse or toe deformity (such as claw toe), further increasing the risk of friction and ulcers.
2. Vascular lesions: The “Crisis of Blood Stasis” in the feet
High blood sugar can lead to atherosclerosis of the lower extremity arteries, narrowing or even occlusion of the vascular lumen, resulting in “ischemic diabetic foot”. Patients often present with:
Intermittent claudication: After walking several hundred meters, there is soreness and pain in the lower leg, which eases after rest.
Resting pain: Severe pain in the feet when lying flat at night, which can only be relieved by hanging the limb.
Cold feet and pale complexion: The pulsation of the dorsal artery of the foot weakens or disappears. In severe cases, the feet turn black and necrotic (dry gangrene).
3. Infection: A “Deadly Storm” Triggered by Small Wounds
Nerve and vascular diseases make the skin on the feet fragile. Once there is any damage (such as corns, athlete’s foot, or friction from shoes and socks), bacteria (mostly Staphylococcus aureus and Escherichia coli) will multiply rapidly. Due to the decline in immunity caused by ischemia, the infection can spread to the muscles and bones within 24 to 48 hours, leading to “wet gangrene”, and even sepsis and septic shock.
Ii. Early Identification: “Danger Signals” and Classification of Diabetic Foot
1. Be vigilant against “painless injuries”
The early symptoms of diabetic foot are often overlooked, especially for patients with neuropathy who may not feel the pain. Key focus:
Abnormal skin conditions: dryness, flaking, cracking, or the appearance of blisters, redness, swelling, and pigmentation;
Deformity changes: curved toes (claw-shaped toes), protruding metatarsal heads (forming “calluses”), flattened arches (flat feet);
Abnormal walking: Unsteady gait, foot pressure concentrated in a certain area (such as the front sole or heel).
2. International Wagner Classification: Judging the severity of the disease
Symptom classification describes the risk of amputation
Grade 0: With neurological/vascular lesions but no open wounds, low risk (preventive intervention is required)
Grade 1 superficial ulcer, no moderate risk of infection (local treatment required)
Grade 2 ulcers reach deep into tendons and bones. There is no high risk of osteomyelitis (surgical debridement is required)
Grade 3 ulcer with osteomyelitis or abscess is at extremely high risk (amputation may occur)
Emergency surgery (toe amputation) for grade 4 localized gangrene (such as toe necrosis)
Grade 5 total foot gangrene amputation (lower leg or thigh)
Iii. Scientific Treatment: The “Multidisciplinary Collaboration” Program for Diabetic Foot
The treatment of diabetic foot requires “blood sugar control as the foundation, local treatment as the core, and systemic support as the guarantee”, involving a multidisciplinary team including endocrinology, vascular surgery, orthopedics, and infectious diseases.
1. Basic treatment: Strictly control blood sugar and overall condition
Blood glucose management: Target fasting blood glucose < 7.0mmol/L, 2-hour postprandial blood glucose < 10.0mmol/L, glycated hemoglobin (HbA1c) < 7%; Insulin therapy is the first choice during the ulcer stage, and oral hypoglycemic drugs should be avoided (which may affect liver and kidney functions).
Improve circulation: Use aspirin, clopidogrel for antiplatelet, and alprostadil (prostaglandin E1) for vasodilation; Patients with severe ischemia require interventional treatment (balloon dilation, stent implantation) or arterial bypass surgery.
2. Local Treatment: From “Debridement” to “Repair
Wound assessment: Determine whether osteomyelitis or abscess exists through ultrasound, X-ray or MRI;
Debridement: Thoroughly remove necrotic tissue and select dressings based on the type of wound (such as wet healing dressings to promote granulation tissue growth and antibacterial dressings to control infection);
Negative pressure closed drainage (VSD) : It is suitable for deep and large wounds. It promotes blood circulation through negative pressure and accelerates healing.
3. Infection Control: The “Double Blow” of Antibiotics and Surgery
Empirical medication: Initially use broad-spectrum antibiotics (such as cefoperazone sulbactam), and later adjust according to the results of bacterial culture;
Surgical intervention: Osteomyelitis requires drilling and drainage or osteotomy, and gangrene patients need timely amputation to save lives.
Iv. Prevention is Better than Cure: The “Five-Step Rule for Foot Care in Diabetic Foot”
Eighty percent of amputations due to diabetic foot can be avoided through prevention. Daily management should include “daily check-ups, scientific care, proper shoe wearing, and regular screening”.
1. Daily foot self-examination: No detail is overlooked
Examination time: Before going to bed every night, observe your feet in a well-lit area or using a mirror;
Examination items: Whether the skin is damaged, whether there are blisters, whether the toenails are ingrown or thickened (be alert to fungal infection);
Youdaoplaceholder6 Special note: When comparing your feet, pay attention to hidden areas such as the Spaces between your toes and the soles of your feet.
2. Scientific foot care: The four-step process of “washing, rubbing, moisturizing and trimming”
For foot washing: Use warm water at 37-40℃ (measure with a water thermometer to avoid scalding), wash with neutral soap, and soak for less than 10 minutes.
To dry: Gently pat with a soft towel (do not rub too hard), focusing on drying the moisture between the toes.
Moisturizing: Apply non-irritating moisturizing cream (avoid the Spaces between the toes) to relieve dry and chapped skin;
Nail trimming: Trim the toenails straight to avoid damaging the nail groove. For those with poor eyesight, assistance from family members is required.
3. Shoe and Sock Selection: The “First Line of Defense” against Diabetic Foot
Shoes: Choose sports shoes with round toe, soft sole, breathable, no seams inside the shoes (to avoid friction), and heel height < 3cm; New shoes should be worn for one hour every day to gradually get used to them.
Socks: Pure cotton or wool socks, light-colored (for easy detection of bleeding), without elastic bands (to avoid ankle compression), change daily;
Taboos: Do not wear slippers or high heels. Barefoot walking is prohibited (even at home).
4. Regular professional screening: Have a “foot check-up” once a year
Spinal nerve examination: 10g nylon monofilament test for pressure sensation, tuning fork test for vibration sensation;
Vascular examination: ankle-brachial index (ABI) measurement (normal value 0.9-1.3, < 0.9 indicates ischemia);
High-risk groups: Those with a disease course of more than 10 years, those with hypertension/hyperlipidemia, and those with a history of smoking should be screened every 6 months.
5. Lifestyle adjustment: Control risk factors
Smoking cessation: Smoking can aggravate vascular spasm and increase the risk of amputation by three times.
Continuous exercise: Choose non-weight-bearing exercises such as swimming and cycling, and avoid walking or standing for long periods of time.
Blood glucose monitoring: Always carry a blood glucose meter with you to avoid hypoglycemia (which may cause falls and injuries).
Protecting your feet is protecting your life; details determine the outcome
Diabetic foot is one of the most serious chronic complications of diabetes, but it is not an incurable disease. From blood sugar control to daily foot care, from early identification to multidisciplinary treatment, every link is related to the quality of life and life safety of patients. Remember: A pair of healthy feet is the cornerstone for diabetic patients to live a long life. Let’s join hands and integrate “foot care” into our daily management to stay away from the threat of diabetic foot.
【 Health Tip 】 If you notice a wound on your foot that has not healed within 2 days, shows redness, swelling, heat, pain or fever, seek medical attention immediately!
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Post time: Dec-11-2025