ABSTRACTAims/IntroductionFew people have reported whether there are sex differences in blood lipids and lipid ratios in type 2 diabetic foot (T2DF) patients in China. This study attempts to identify the contribution to sex‐specific differences in blood lipids and lipid ratios in these patients.Materials and MethodsIn this case–control study, we explore 306 patients with T2DF as the study group and 306 patients with type 2 diabetes mellitus as the control group. Patients were diagnosed according to the Standards of Medical Care in Diabetes–2014 (American Diabetes Association). Blood lipid and lipid ratios were determined according to the National Cholesterol Education Program Adult Treatment Panel III criteria.ResultsWe studied male patients with T2DF who were aged 68.00 years (18.00 years) and females who were aged 73.50 years (19.00 years); 61.76% of the patients were men. Men had higher body mass index and glycated hemoglobin levels than women. Compared with type 2 diabetes mellitus patients, T2DF patients had significant differences in total cholesterol/high‐density lipoprotein cholesterol (HDL‐C), low‐density lipoprotein cholesterol/HDL‐C and apolipoprotein (apo)B/apoA‐I ratios. HDL‐C, triglyceride, apoA‐I and apoB/apoA‐I ratio showed cardiovascular disease risk in men, whereas total cholesterol, low‐density lipoprotein cholesterol, apoB, and the low‐density lipoprotein cholesterol/HDL‐C and total cholesterol/HDL‐C ratios were better predictors in women. The apoB/apoA‐I ratio odds ratio values were 2.18 (95% confidence interval 1.17–4.41) and 2.14 (95% confidence interval 1.14–4.00) in male patients with T2DF before and after adjusting for age, respectively (P < 0.05).ConclusionsT2DF patients present sex‐specific differences in their blood lipid and lipid ratios, especially in the apoB/apoA‐I ratio, which could be a better indicator for cardiovascular disease risk.