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Diabetology
Special Issues
Prevention and Care of Diabetic Foot Ulcers
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Prevention and Care of Diabetic Foot Ulcers

A special issue of Diabetology (ISSN 2673-4540).

Deadline for manuscript submissions: 15 January 2027 | Viewed by 16741

Editors

Dr. Roberto Da Ros

E-Mail Website
Guest Editor
Diabetes and Diabetic Foot Treatment Center, Gorizia and Monfalcone Hospital (ASUGI), Monfalcone, Italy
Interests: diabetes; diabetic foot ulcers; wound healing; osteomyelitis; ulcer prevention
Dr. Cesare Miranda

E-Mail Website
Guest Editor
ASFO Pordenone Hospital, Clinical Endocrinology and Metabolic Diseases Department, Pordenone, Italy
Interests: type 2 diabetes; diabetic foot syndrome; sulfonylureas; adjuvant wound treatments; autologous cell therapy

Special Issue Information

Dear Colleagues,

Diabetic foot is a serious complication of diabetes with a high impact on healthcare systems due to the cost of care. Moreover, ulcers are the key factor that often precedes amputation. From this perspective, prevention is crucial to stopping the chain of events that leads to lesions and, ultimately, amputation.

In the care of people with diabetes, greater attention should be paid to preventing the onset of ulcers. Preventive measures can begin with primary prevention, focusing on effective diabetes management, proper assessment of the at-risk foot, and patient education. Secondary prevention is equally important; these interventions aim to prevent recurrence, which is one of the most frequent events, affecting over 50% of patients who have healed within a year. The possibilities for action in this case are multi-faceted: surgical with preventive procedures, orthotic by providing patients with the most appropriate footwear, and educational by informing patients about the risks associated with their feet.

Dr. Roberto Da Ros
Dr. Cesare Miranda
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diabetology is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • diabetic foot
  • prevention
  • diabetic foot ulcer
  • wound
  • recurrence

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Published Papers (7 papers)

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Research

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18 pages, 1647 KB  
Article
Cost-Effectiveness of Pressure-Guided-Offloading-Improved Custom-Made Footwear for People with Diabetes at High Risk of Plantar Foot Ulceration
by Sicco A. Bus, Jaap J. van Netten, Diekje R. Schouten and Marcel G. W. Dijkgraaf
Diabetology 2026, 7(4), 70; https://doi.org/10.3390/diabetology7040070 - 2 Apr 2026
Viewed by 1251
Abstract
Background: Custom-made footwear that improves offloading using in-shoe pressure-guided techniques, when worn as recommended, reduces the risk of diabetic foot ulcer recurrence. We aimed to assess the cost-effectiveness of this approach, as it requires extra investments in equipment and personnel, and implementation is [...] Read more.
Background: Custom-made footwear that improves offloading using in-shoe pressure-guided techniques, when worn as recommended, reduces the risk of diabetic foot ulcer recurrence. We aimed to assess the cost-effectiveness of this approach, as it requires extra investments in equipment and personnel, and implementation is not yet widespread. Methods: We conducted an economic evaluation using data from the DIAFOS RCT that randomized 171 participants at high ulcer risk to either pressure-guided-offloading-improved (intervention) or non-pressure-guided (usual care) custom-made footwear. The clinical outcome was the 18-month ulcer recurrence incidence, available from the RCT. Costs were modeled from a partial healthcare perspective using bottom-up unit cost calculation, with ulcer treatment costs obtained from reference data. Univariable regression analyses were executed to obtain incremental cost-effectiveness ratios (ICERs). Bootstrapping techniques accounted for uncertainty. Results: For the intervention, costs for ulcer recurrence were non-significantly lower (€−436; 95% CI: €−1434; €563) than for usual care. The ICER was €−8124 (i.e., costs saved to prevent one extra participant from having an ulcer), and the maximum probability for cost-effectiveness was 0.81. In the subgroup of participants who were adherent to wearing their prescribed footwear, costs for the intervention were non-significantly lower at €−1170 (95% CI: €−2595; €254), with ICER of €−5317, and a maximum probability for cost-effectiveness of 0.94. Conclusions: The use of in-shoe pressure-guided-offloading-improved custom-made footwear to help prevent diabetic foot ulcer recurrence is cost-effective with high probability when ulcer treatment costs are considered. Probability further increases when users adhere to their footwear. Future economic analyses should consider a full healthcare and societal perspective and use prospectively collected data on ulcer treatment costs. Full article
(This article belongs to the Special Issue Prevention and Care of Diabetic Foot Ulcers)
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11 pages, 692 KB  
Article
Oxygen-Enriched Oil-Based Dressing: A New Option for Tunneling Post-Surgical Diabetic Foot Ulcers
by Alessia Scatena, Sara Sandroni, Matteo Apicella, Michele Mantuano, Anna Ranchelli, Emanuele Bartolini, Rosa Nigro, Sofia Butini, Teresa Scognamiglio, Tommaso Anichini and Marco Meloni
Diabetology 2026, 7(3), 55; https://doi.org/10.3390/diabetology7030055 - 6 Mar 2026
Viewed by 890
Abstract
Background: Postoperative wounds may arise from several etiologies, including open partial pedal amputation, postoperative infection, and dehiscence of surgical sites from wound failure or patient compliance issues. If negative pressure wound therapy is the gold standard, its application in the toes area could [...] Read more.
Background: Postoperative wounds may arise from several etiologies, including open partial pedal amputation, postoperative infection, and dehiscence of surgical sites from wound failure or patient compliance issues. If negative pressure wound therapy is the gold standard, its application in the toes area could be challenging, and as a consequence, standard care is most likely used. The control of the wound microenvironment, both in terms of pH levels and presence of reactive oxygen species, is a key part of the normal wound-healing process. This study evaluated the effectiveness of an oxygen-enriched oil-based device (OEOd) in post-surgical diabetic foot ulcers (DFUs). Methods: This prospective controlled comparative pilot study enrolled 40 patients with diabetes mellitus and post-surgical foot wounds (narrow and deep lesions, including tunneling ulcers) treated at the Diabetic Foot Unit of San Donato Hospital, Arezzo (March 2024–April 2025). Patients were allocated into two groups: those treated by the standard wound care (n = 20) and those treated by OEOd (n = 20). The primary outcome was complete wound healing at 16 weeks; other exploratory endpoints were wound area reduction at 4 and 16 weeks, onset of infection, need for re-intervention, and adverse events. Results: Complete wound healing was achieved in 85.0% of OEOd patients versus 45.0% in the control group (p = 0.020). At 16 weeks, wound area reduction was significantly greater in the OEOd group compared with standard therapy (89.8% vs. 64.0%, p = 0.013). Although infection rates (10.0% vs. 35.0%, p = 0.130) and need for re-intervention (0% vs. 25.0%, p = 0.056) did not reach statistical significance, both favored the OEOd group. No adverse events were reported. Conclusions: OEOd significantly improved the chance of healing post-surgery and showed favorable trends in reducing complications, with an excellent safety profile. Larger randomized controlled trials are warranted to confirm these findings and assess long-term outcomes. Full article
(This article belongs to the Special Issue Prevention and Care of Diabetic Foot Ulcers)
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13 pages, 507 KB  
Article
Outcomes of Patients Admitted for Infected Diabetic Foot Attack: Difference Between Patients with and Without Peripheral Artery Disease
by Federico Rolando Bonanni, Marco Meloni, Martina Salvi, Ermanno Bellizzi, Luigi Uccioli, Valeria Ruotolo, Aikaterini Andreadi, Alfonso Bellia and Davide Lauro
Diabetology 2026, 7(2), 39; https://doi.org/10.3390/diabetology7020039 - 12 Feb 2026
Viewed by 1277
Abstract
Objectives: To assess the impact of peripheral artery disease (PAD) on the outcomes of patients admitted for infected diabetic foot attack (DFA). Methods: Retrospective observational study of consecutive patients admitted to a third-level multidisciplinary diabetic foot service in 2024 for diabetic [...] Read more.
Objectives: To assess the impact of peripheral artery disease (PAD) on the outcomes of patients admitted for infected diabetic foot attack (DFA). Methods: Retrospective observational study of consecutive patients admitted to a third-level multidisciplinary diabetic foot service in 2024 for diabetic foot ulcers (DFUs) complicated by moderate or severe infection. Based on the presence of PAD, patients were divided into two groups: those with neuro-ischemic DFA (PAD+), treated with prompt revascularization, and those with neuropathic DFA (PAD-). The following in-hospital outcomes were evaluated: minor and major amputations; length of stay (LOS); mortality. Once discharged, patients were regularly followed as outpatients, and their six-month outcomes (healing, major amputation, and mortality) were analyzed. Results: Overall, 119 patients were included (70% PAD+ vs. 30% PAD-). The mean age was 67 ± 13 years, most patients were male (75%) and had type 2 diabetes (92%) with a mean duration of 20 ± 12 years. In-hospital outcomes for the two groups (PAD+ vs. PAD-) were as follows: minor amputation (41.7 vs. 25.7%, p = 0.09); major amputation (2.4 vs. 2.9%, p = 0.8); LOS (21 ± 11 vs. 14 ± 11 days, p = 0.004); mortality (3.6 vs. 0%, p = 0.1). The six-month follow-up outcomes (PAD+ vs. PAD-) were as follows: healing (40.5 vs. 90.6%, p < 0.0001); major amputation (8.1 vs. 3.1%, p = 0.1); mortality (8.1 vs. 0%, p = 0.01). Additionally, PAD (OR 3.6, CI: 1.4–12.1, p = 0.001) was independently related to non-healing. Conclusions: In the context of infected DFA, PAD appeared to play a significant role only in hospitalization length, while having greater influence on mid-term outcomes at the six-month follow-up, particularly in reducing healing chances. Full article
(This article belongs to the Special Issue Prevention and Care of Diabetic Foot Ulcers)
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Review

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28 pages, 1642 KB  
Review
Evaluation of the Present Perspective on Diabetic Foot Syndrome and Health Education and Analysis of the Impact of Educational Interventions: A Systematic Review and Meta-Analysis
by Sol Tejeda-Ramírez, José Luis Lázaro-Martínez, Esther García-Morales, Sara García-Oreja, Laura Palacios-Abril and Aroa Tardáguila-García
Diabetology 2026, 7(4), 69; https://doi.org/10.3390/diabetology7040069 - 2 Apr 2026
Viewed by 1473
Abstract
Aims: To evaluate the effectiveness of preventive educational interventions in individuals with diabetic foot syndrome (DFS) and to summarise current evidence on knowledge, self-care and health-education strategies related to this complication. Materials and methods: A systematic review and meta-analysis was conducted [...] Read more.
Aims: To evaluate the effectiveness of preventive educational interventions in individuals with diabetic foot syndrome (DFS) and to summarise current evidence on knowledge, self-care and health-education strategies related to this complication. Materials and methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Risk of bias was evaluated using the Cochrane Handbook recommendations. Analyses were performed with Review Manager v5.4.1. Results: Educational interventions produced a significant improvement in patient knowledge and self-care practices compared with usual care. Despite some heterogeneity across studies, the overall effect favoured structured education as a preventive strategy for DFS-related complications. Conclusions: Preventive educational interventions enhance knowledge and self-care among individuals with DFS. Implementing structured education programs may help reduce complications and improve clinical outcomes. Full article
(This article belongs to the Special Issue Prevention and Care of Diabetic Foot Ulcers)
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18 pages, 1119 KB  
Review
Infrared Thermography in Diabetic Foot Assessment: Review
by Thelma I. Morales-Ramírez, Daniel Román-Rojas and Aurora Espinoza-Valdez
Diabetology 2026, 7(3), 47; https://doi.org/10.3390/diabetology7030047 - 3 Mar 2026
Viewed by 2063
Abstract
One of the most common and severe complications of diabetes mellitus is diabetic foot, making early detection a public health priority. Infrared thermography is a promising noninvasive technique for identifying abnormal thermal patterns associated with inflammation, neuropathy, angiopathy, and tissue damage. This technique [...] Read more.
One of the most common and severe complications of diabetes mellitus is diabetic foot, making early detection a public health priority. Infrared thermography is a promising noninvasive technique for identifying abnormal thermal patterns associated with inflammation, neuropathy, angiopathy, and tissue damage. This technique involves acquiring infrared radiation emitted by the skin and processing it to generate thermal maps that reflect underlying physiological changes. However, the reliability of thermographic assessments depends on strict technical conditions, including sensor performance, environmental control, and reproducible measurements. Despite its advantages, the clinical adoption of thermography is limited by the absence of standardized acquisition protocols and the influence of external and physiological factors on temperature measurements. Addressing these challenges is essential to ensure the accurate interpretation and validation of results. Recent advances, such as the incorporation of artificial intelligence algorithms and the development of portable, low-cost devices, offer new opportunities to enhance thermography’s applicability in clinical settings and home monitoring. Full article
(This article belongs to the Special Issue Prevention and Care of Diabetic Foot Ulcers)
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12 pages, 684 KB  
Review
New Therapeutic Perspectives for the Management of Diabetic Foot Through Regenerative Medicine
by Diego Castro Musial, Talita Ferreira Marques Aguiar and Guilherme H. Souza Bomfim
Diabetology 2026, 7(2), 35; https://doi.org/10.3390/diabetology7020035 - 9 Feb 2026
Cited by 1 | Viewed by 2098
Abstract
Diabetic foot ulcers (DFUs) are among the most severe and costly complications of diabetes, affecting millions of individuals worldwide. This narrative review summarizes major advances in regenerative medicine relevant to the management of DFUs and discusses how these approaches contribute to faster and [...] Read more.
Diabetic foot ulcers (DFUs) are among the most severe and costly complications of diabetes, affecting millions of individuals worldwide. This narrative review summarizes major advances in regenerative medicine relevant to the management of DFUs and discusses how these approaches contribute to faster and more effective wound healing. Stem cell-based therapies, particularly those using adipose-derived mesenchymal stem cells (AD-MSCs), have demonstrated promising clinical outcomes through their ability to modulate inflammation, promote angiogenesis, and support skin and soft tissue regeneration. Platelet-rich plasma (PRP), an accessible autologous therapy, delivers concentrated growth factors that accelerate wound closure, enhance neovascularization, and shorten healing time compared with standard care. In addition, decellularized extracellular matrix (dECM) scaffolds provide a biologically active structural framework that supports cell adhesion, tissue remodeling, and granulation tissue formation. Collectively, these regenerative strategies offer new perspectives for improving functional recovery and quality of life in patients with DFUs, transforming chronic non-healing wounds into opportunities for effective tissue repair. Full article
(This article belongs to the Special Issue Prevention and Care of Diabetic Foot Ulcers)
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Other

Jump to: Research, Review

16 pages, 1020 KB  
Systematic Review
Negative-Pressure Wound Therapy in Diabetic Foot Management: Synthesis of International Randomized Evidence over Two Decades
by George Theodorakopoulos and David G. Armstrong
Diabetology 2025, 6(11), 126; https://doi.org/10.3390/diabetology6110126 - 1 Nov 2025
Cited by 1 | Viewed by 5935
Abstract
Background: Diabetic foot ulcers (DFUs) carry high risks of infection, amputation, and mortality. We systematically reviewed randomized controlled trials (RCTs) of negative-pressure wound therapy (NPWT), including single-use systems, for clinically uninfected DFUs (with sensitivity analyses for mixed/infected cohorts). Methods: We searched PubMed and [...] Read more.
Background: Diabetic foot ulcers (DFUs) carry high risks of infection, amputation, and mortality. We systematically reviewed randomized controlled trials (RCTs) of negative-pressure wound therapy (NPWT), including single-use systems, for clinically uninfected DFUs (with sensitivity analyses for mixed/infected cohorts). Methods: We searched PubMed and Scopus (1 January 2004–30 June 2024). Dual reviewers performed screening and extraction; risk of bias was assessed with Cochrane Risk of Bias 2 (RoB 2) and certainty of evidence with GRADE. When ≥2 trials reported comparable outcomes, we used random-effects meta-analysis. The DiaFu cohort reported in two publications was counted once across analyses. Results: Eleven RCT publications (n = 1699; 10 unique cohorts) met criteria; eight trials (n = 1456) informed the primary endpoint. Trials largely excluded severe ischemia; findings therefore apply mainly to neuropathic or mixed-etiology DFUs with adequate perfusion. NPWT increased complete healing at 12–16 weeks (risk ratio [RR] 1.46, 95% CI 1.21–1.76; I2 = 48%) and shortened time to healing (mean difference –18 days, 95% CI −28 to −8). Effects were similar for conventional and single-use NPWT. Outcomes did not vary systematically within commonly used pressure ranges (approximately −80 to −125 mmHg). Only two RCTs reported direct cost data (exploratory). Moderate heterogeneity (Higgins’ I2 48–68%) reflected variation in ulcer severity, device type/settings, dressing-change frequency, and off-loading protocols. Conclusions: NPWT probably improves short-term healing of clinically uninfected DFUs compared with standard care and may reduce minor amputations, without increasing adverse events. Certainty is moderate for healing and low for most secondary outcomes. Benefits appear consistent across device classes and may support earlier discharge and community-based care. Evidence gaps include ischemia-dominated ulcers, long-term outcomes (recurrence and limb preservation), adherence mechanisms, and contemporary cost-effectiveness. Full article
(This article belongs to the Special Issue Prevention and Care of Diabetic Foot Ulcers)
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