To investigate elephant-skin powder for the treatment of diabetic foot in stage IV level 4/4-D， and provide treatment and nursing experience. Methods: Divided 101 cases into treatment and control groups randomly， gave elephant-skin powder with traditional Chinese medicine injections， insulin + silver sulfadiazine ointment topical treatment for 4 weeks， observed changes of ulcers size， skin color， skin temperature， paresthesia (hot and cold sense of slow， pain， numbness) and dorsalis pedis artery pulse before and after intervention， respectively. Results: In the treatment of diabetic foot Stage IV level 4/4-D， elephant-skin powder supplemented with traditional Chinese medicine injection can relieve paresthesia， dorsalis pedis artery pulse， skin temperature and color changes. Except paresthesia， improvement of the dorsalis pedis artery pulse， skin temperature， skin color and the overall effects of the treatment group were significant better than the control group (P<0.05). Conclusion: Elephant-skin powder supplemented with traditional Chinese medicine injection can speed up deep fistula pus drainage， improve regeneration of epidermal cells and capillary vessels， promote blood circulation of local organizations and granulation tissue growth. Drug treatment combined with psychological care and foot care， with special attention to skin， vessels， and nerves， is crucial to significantly promote the short-term and long-term efficacies and survival quality of diabetic foot patients in stage IV level 4/4-D.