How to Treat Diabetic Foot: A Comprehensive Guide to Modern Multidisciplinary Care
Diabetic foot is a serious and complex complication of diabetes that requires timely and comprehensive medical intervention. In recent years, awareness and specialized care for diabetic foot have significantly increased across the country, especially in major metropolitan areas such as Beijing and Shanghai. These cities have established dedicated diabetic foot treatment centers, reflecting a growing commitment to advanced patient care and limb preservation.
The Importance of a Multidisciplinary Approach
Treating diabetic foot effectively involves a collaborative effort from multiple medical specialties. It's no longer managed by just one department—instead, it demands an integrated team approach. Key disciplines involved include endocrinology, general surgery, orthopedics, podiatry (foot and ankle surgery), vascular surgery, dermatology, infectious disease specialists, and chronic wound care experts. This multidisciplinary model ensures that every aspect of the condition—from blood sugar control to tissue repair—is addressed systematically.
The Role of Internal Medicine in Diabetic Foot Management
From an internal medicine perspective, the primary focus lies in strict glycemic control. Maintaining stable blood glucose levels is crucial to prevent further complications and support healing. Fluctuating blood sugar can impair immune function and delay wound recovery, making consistent monitoring and insulin or medication adjustments essential components of treatment.
Understanding the Causes of Foot Damage in Diabetes
When it comes to tissue damage in diabetic patients, two main pathological processes are at play: infection and ischemia. These lead to two distinct types of tissue death—wet necrosis and dry gangrene.
Infection-Induced (Wet) Necrosis
Wet necrosis typically results from bacterial infections, often exacerbated by poor hygiene, minor injuries, or ulcers that go unnoticed due to diabetic neuropathy. If left untreated, these infections can spread rapidly into deeper tissues and even bone (osteomyelitis). Early surgical intervention, including debridement—the removal of dead or infected tissue—is critical to halt progression and preserve limb function.
Ischemic (Dry) Gangrene Due to Poor Blood Flow
Dry gangrene occurs when arterial blood flow to the lower limbs is severely restricted—a condition known as peripheral arterial disease (PAD). Without adequate oxygen and nutrients, tissues begin to die, leading to blackened, shriveled extremities. Unlike wet necrosis, this form isn't primarily driven by infection but by lack of circulation. In such cases, restoring blood flow becomes the top priority.
Modern Surgical Interventions That Save Limbs
Surgical treatment has evolved dramatically over the past decade, significantly reducing the need for amputation. Vascular surgery plays a central role, particularly through minimally invasive procedures like angioplasty and stenting to reopen blocked arteries. When large vessels are affected, endovascular interventions can restore circulation and promote natural healing.
Advancements in Foot and Ankle Surgery
Podiatric and orthopedic surgeons now use innovative techniques such as bone transport surgery—a regenerative method where small segments of bone are gradually moved to stimulate new blood vessel formation and improve local perfusion. This cutting-edge procedure not only helps heal chronic ulcers but also enhances overall foot stability and function.
Why Amputation Rates Are Declining
In the past, limb amputation was often the default solution for severe diabetic foot complications. However, thanks to early diagnosis, better imaging technologies, aggressive infection control, and advanced reconstructive methods, the rate of major amputations has been steadily decreasing. Today's goal is clear: limb salvage and improved quality of life.
Patients with diabetic foot syndrome must receive prompt, coordinated care. With the right combination of medical management, surgical expertise, and ongoing foot care education, many individuals can avoid amputation and maintain mobility. As research continues and treatment protocols improve, the future looks increasingly hopeful for those living with this challenging condition.