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Diabetology
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All Toes Considered for Diabetic Foot: Prevention, Treatment, and Healthcare...
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All Toes Considered for Diabetic Foot: Prevention, Treatment, and Healthcare Policy

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

Deadline for manuscript submissions: 20 December 2026 | Viewed by 3316

Editors

Dr. Chia-Ding Shih

E-Mail Website
Guest Editor
1. Division of Vascular Surgery and Endovascular Therapy, Keck Medicine of USC, Los Angeles, CA 90033, USA
2. College of Podiatric Medicine, Samuel Merritt University, Oakland, CA 94609, USA
Interests: diabetic foot; amputation prevention; healthcare policy; wound care; biomechanics
Dr. Miguel Manzur

E-Mail Website
Guest Editor
Division of Vascular Surgery and Endovascular Therapy, Keck Medicine of USC, Los Angeles, CA 90033, USA
Interests: limb salvage; peripheral arterial disease; diabetic foot
Dr. Sofia Sakellaridi

E-Mail Website
Guest Editor
1. Casa Colina Research Institute, Casa Colina Hospital and Centers for Healthcare, 255 East Bonita Avenue, Building 4A, Pomona, CA 91767, USA
2. Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
Interests: cognitive neuroscience; statistical analysis; machine learning
Dr. David G. Armstrong

E-Mail Website
Guest Editor
Division of Vascular Surgery and Endovascular Therapy, Keck Medicine of USC, Los Angeles, CA 90033, USA
Interests: limb salvage; diabetic foot; wound healing

Special Issue Information

Dear Colleagues,

Diabetic foot complications—including chronic ulceration, infection, and subsequent amputation—are a major driver of healthcare expenditure and are associated with unacceptably high mortality. The lifetime risk of developing a diabetic foot ulcer is approximately 34%, and such ulcers precede at least 85% of lower-extremity amputations. Five-year mortality following a diabetic foot ulcer or amputation surpasses 50%, exceeding that of many common cancers. The causes of diabetic foot complications are multifactorial: neuropathy impairs protective sensation, autonomic regulation, and musculoskeletal innervation, predisposing to tissue breakdown and recurrent wounds; diabetic angiopathy compromises perfusion and further contributes to impaired healing, especially in the presence of kidney disease. Beyond pathophysiology, gaps in healthcare delivery and policy can delay timely diagnosis, referral, and treatment. The consequences are profound, including limb loss and increased risk of death. Given this complexity, this Special Issue will encompass topics ranging from population-level analyses to clinical trials, and from prevention strategies to novel surgical and technological interventions, with the shared goal of reducing diabetic foot–related amputations.

Dr. Chia-Ding Shih
Dr. Miguel Manzur
Dr. Sofia Sakellaridi
Dr. David G. Armstrong
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
  • amputation prevention
  • limb salvage
  • healthcare policy
  • wound care
  • surgical offloading

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Published Papers (2 papers)

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Research

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17 pages, 2747 KB  
Article
Monitoring Diabetic Foot Using Images and Generative AI
by Afonso Nobre and João Silva Sequeira
Diabetology 2026, 7(5), 95; https://doi.org/10.3390/diabetology7050095 - 12 May 2026
Viewed by 644
Abstract
Background: Diabetic Foot Ulcers (DFU) are a common complication of diabetes, often leading to infections, amputations and even death if left untreated. Effective management of the Diabetic Foot (DF) requires timely detection and frequent monitoring. Current DF assessment methods, by healthcare professionals, [...] Read more.
Background: Diabetic Foot Ulcers (DFU) are a common complication of diabetes, often leading to infections, amputations and even death if left untreated. Effective management of the Diabetic Foot (DF) requires timely detection and frequent monitoring. Current DF assessment methods, by healthcare professionals, are largely based on visual inspection of feet, together with touch, temperature, and vibration sensitivity, and pedal pulse. Methods: The paper describes a machine-learning approach for the assessment of DF from feet images, combining pre-trained convolutional neural networks (CNN) with Generative AI for dataset annotation. Specifically, the GPT-4o-mini model was used to assign risk labels (Low, Medium or High Risk) to individual foot images, following a structured designed prompt for this task. The labeled dataset was used to train and evaluate two pre-trained CNN architectures, namely, ResNet50 and VGG16. Output predictions are obtained by aggregating the prediction for each of the images of a patient. Results: The results obtained show that both ResNet50 and VGG16 achieved good overall performance, with ResNet50 showing superior results. The High Risk class achieved the highest performance. The Low and Medium Risk classes also showed good performance but were prone to confusion due to the similar features of the images belonging to those classes. Conclusions: The technical contribution of the paper is a Streamlit App, available online for public use, showcases the work. The primary scientific contribution is the demonstration of how Generative AI can be used to train common CNN and automate a highly relevant healthcare process. Full article
(This article belongs to the Special Issue All Toes Considered for Diabetic Foot: Prevention, Treatment, and Healthcare Policy)
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Review

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10 pages, 1617 KB  
Review
From Plaster to Pixels: The Evolution of Offloading in the Diabetic Foot
by David G. Armstrong, Bijan Najafi and Shervanthi Homer-Vanniasinkam
Diabetology 2026, 7(3), 44; https://doi.org/10.3390/diabetology7030044 - 1 Mar 2026
Cited by 1 | Viewed by 1457
Abstract
Offloading remains the cornerstone of diabetic foot ulcer (DFU) management. This review traces the evolution of mechanical offloading from early plaster casting in South Asian leprosy clinics to modern removable walkers and emerging “SmartBoot” technologies. We examine the historical progression from total contact [...] Read more.
Offloading remains the cornerstone of diabetic foot ulcer (DFU) management. This review traces the evolution of mechanical offloading from early plaster casting in South Asian leprosy clinics to modern removable walkers and emerging “SmartBoot” technologies. We examine the historical progression from total contact casting (TCC) through the era of randomized trials and instant TCC (iTCC), up to the current integration of wearable sensors and digital adherence tools. Contemporary evidence—including meta-analyses—is discussed to compare the effectiveness of offloading modalities (non-removable vs. removable devices, knee-high vs. ankle-high boots, therapeutic footwear, and adjunctive surgeries). Current challenges, such as patient adherence, frailty, and balance, are linked to technological responses like smart insoles, remote monitoring, and gamification strategies. Through this historical and evidence-based lens, we highlight how decades-old biomechanical principles are being reimagined with 21st-century innovations, aiming to improve healing rates and patient engagement in DFU care. Full article
(This article belongs to the Special Issue All Toes Considered for Diabetic Foot: Prevention, Treatment, and Healthcare Policy)
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