Misconceptions and health-seeking behavior among diabetic patients regarding foot ulcers: the hidden role of circulatory awareness in preventing amputation

Introduction Diabetic foot ulcers (DFUs) are a leading cause of preventable amputation worldwide. Patient misconceptions and poor circulatory awareness are underrecognized drivers of delayed presentation in Saudi Arabia. This study aimed to assess DFU-related misconceptions, circulatory awareness, and health-seeking behavior, and identify predictors of delayed care-seeking. Methods A cross-sectional study was conducted between February and April 2026 among 574 adult diabetic patients attending 11 outpatient facilities in Riyadh, Saudi Arabia. A validated structured questionnaire assessed misconceptions, circulation awareness, health-seeking behavior, and prior education sources. Descriptive statistics, t -tests, ANOVA, chi-square, Pearson correlation, and binary logistic regression were applied; significance was set at p < 0.05. Results The mean misconception score was 3.04 ± 0.34 (scale 1–5); 55.6% indicated a wound warrants attention only when painful, 65.0% stated they would delay care for a painless blister, and 50.7% would wait for pain before treating a painless ulcer. Circulation awareness averaged 3.25 ± 0.38; only 28.4% adequately distinguished nerve damage from circulatory impairment. Only 45.6% had received structured foot care education, while internet or social media (61.9%) outranked healthcare providers (35.9%) as the primary information source. Male sex (OR = 1.536, 95% CI 1.092–2.161, p = 0.014) and longer diabetes duration (OR = 1.258, 95% CI 1.049–1.509, p = 0.014) were the only independent predictors of high delay propensity. Conclusion Saudi diabetic patients demonstrated substantial DFU misconceptions and delay propensity, with pain-centric beliefs and inadequate formal education as key contributing factors. Structured, circulation-focused patient education within primary and family medicine settings may help address delayed presentation and support amputation prevention efforts.