Berberine local injections improve diabetic foot ulcer healing by **18.7%** post-osteotomy, inhibiting `PDGF-B/PDGFRβ`.

Diabetic foot ulcers (DFUs) represent a severe complication of diabetes, often leading to amputation. Tibial transverse osteotomy (TTO) is a surgical intervention aimed at improving blood flow and offloading pressure, but its efficacy in promoting complete ulcer healing remains suboptimal. Current treatments often struggle with persistent inflammation and impaired angiogenesis, critical factors in non-healing wounds. Berberine, a natural isoquinoline alkaloid, is recognized for its anti-inflammatory, pro-angiogenic, and metabolic regulatory properties, making it a compelling candidate to augment DFU healing by targeting pathways like PDGF-B/PDGFRβ.

This prospective, single-center, randomized, placebo-controlled, parallel-group, blinded trial enrolled 96 Diabetic Foot patients (Wagner grade 2-4) undergoing TTO. Participants were randomized 1:1 to receive TTO plus local berberine injections (n=48) or TTO plus local saline placebo (n=48). The primary outcome was the total effective rate of ulcer healing at 3 months. Secondary outcomes included changes in Ankle-Brachial Index (ABI), ulcer area, VAS pain score, and serum inflammatory markers (hs-CRP, IL-6). Exploratory outcomes assessed serum VEGF, bFGF, PDGF-B levels, and fibroblast apoptosis.