Greetings from Shijiazhuang, Hebei Province — a place that has quietly become one of the most important laboratories for diabetic foot and limb preservation work anywhere in the world.
This past Friday, May 22, I had the privilege of joining the Chinese Diabetes Symposium (SIDC) and the China Resources Double-Crane Pharmaceutical (CRDC) satellite session in Shijiazhuang, alongside an extraordinary group of colleagues working at the intersection of diabetes, vascular medicine, and limb preservation. Two sessions — both pointed at the same question we keep coming back to: how do we keep more people walking?
The Plenary: The Team Approach to Limb Preservation
In the SIDC plenary, I shared a talk whose central thesis remains stubbornly simple. The diabetic foot is not a foot problem. It is a system problem. And system problems get solved by teams willing to behave as systems: podiatric and vascular surgery, endocrinology, infectious disease, plastics, nursing — and always the patient and family. Toe-and-flow is not a slogan; it is a survival strategy. Re-ulceration is the rule, not the exception, and we owe our patients a remission model, not just a healing one.
A Hands-On WIfI Consultation and the Biology of Wound Healing
In the afternoon, we shifted to a hands-on WIfI (Wound, Ischemia, foot Infection) classification consultation with the wonderful Prof. Lianrui Guo and a room full of vascular and limb preservation colleagues. WIfI is a beautifully simple language for an impossibly complicated problem — a way to talk about CLTI patients across specialties, across hospitals, and across cultures using a common vocabulary. Watching Chinese vascular surgeons stratify their own cases in real time was, frankly, exhilarating. The classification works. The team works. The language is portable. We also discussed the biology of healing.
A Few Observations from the Road
The energy around diabetic foot disease and CLTI in China right now is remarkable. The volume is daunting. The appetite for structured, multidisciplinary approaches is even bigger. Many of the centers I met are well ahead of where some of us in the U.S. and Europe were a decade ago in terms of integrated workflows. There is real, durable infrastructure being built here — and the patients are the better for it.
The hospitality of Prof. Zhangrong Xu, Prof. Wuquan Deng, gracious beyond description. A welcome dinner with the professoriate the night before set the tone — long table, lazy susan, careful toasts, and the kind of conversation you can only have in person.
Warm thanks to Prof. Lianrui Guo for co-leading the WIfI session, and to all the colleagues who stayed late asking exactly the right questions about offloading, remission, and how to build a limb preservation team in their own hospital. Those are the right questions.
Onward to Shanghai and the 14th CODHy Diabetic Foot session — and then to Guangzhou and Sun Yat-sen.
This is what putting weird ideas together with wonderful people looks like.
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Dear Prof. Amstrong, Thank very much for your supporting Chinese diabetes foot care. We are very happy to have chance to enjoy your very nice talk.