Background and Aims: Diabetic foot (DF) is one of the major causes of disability and death among patients with diabetes. Early diagnosis and standardized treatment of DF can not only increase the efficacy of treatment and accelerate ulcer healing, but also are the effective means for limb salvage and reducing medical costs. This study was conducted to investigate the current status of diagnosis and treatment of DF and the associated factors for the DF patients before referral to a grade A tertiary hospital with specialized multidisciplinary team for dealing with DF, so as to provide the relevant basis for the standardized diagnosis and treatment of this condition. 
Methods: Using a random cluster sampling method design, a total of 326 patients with Wagner's grade 1-5 DF were selected during October to November 2017 from 13 grade A tertiary hospitals with specialized DF treatment center in Hunan, Zhejiang, Shanghai, Sichuan, Guangdong, Hebei, Heilongjiang and Macao, respectively, on whom, the questionnaire survey and foot examination were performed. The selection of wound cleaning fluid and the type of wound medication were used as the assessment criteria to evaluate the normalization of treatment before admission to grade A tertiary hospitals, and the factors that affect the standardization of treatment were analyzed.
Results: Among the 236 DF patients, the misdiagnosis rate was 22.7%, and the rate of non-standard treatment was 72.7%. The results of univariate analysis showed that the degree of treatment standardization was significantly related to the person who performed the debridement, the level of the hospital where the patients were admitted, the person who changed the dressing, the location of the prehospital diagnosis and treatment, the number of complications and the site where the debridement was performed (all P<0.05). The results of Logistic regression analysis revealed that the hospital level and wound dressing person were independent influential factors for the standard treatment rate of DF (both P<0.05), in which, the standard treatment rate of DF in tertiary hospital was 6.707 times higher than that in primary hospital, and was also significantly better than that in secondary hospital; the standard treatment rate of DF with wound dressing performed by wound/ostomy therapists was 24.117 times higher than that performed by patient’s patients themselves, and was also superior to those performed by doctors and nurses.
Conclusion: There are many misdiagnosis and non-standard treatment in DF patients before entering a grade A tertiary hospital with a specialized multidisciplinary team for DF. Therefore, the training on the standardized diagnosis and treatment of DF among medical staff in primary hospitals should be further strengthened and particularly, more attention should be paid to the training of the wound/ostomy therapists; the two-way referral system for DF patients in primary medical institutions and tertiary hospitals should be improved; the patients should be encouraged to seek medical assistance to reduce the occurrence of misdiagnosis and non-standard diagnosis and treatment.