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Diabetic Foot Complications: Current Challenges and Future Prospects—3rd Edition
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Diabetic Foot Complications: Current Challenges and Future Prospects—3rd Edition

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Endocrinology & Metabolism".

Deadline for manuscript submissions: 15 October 2025 | Viewed by 6261

Special Issue Editors

Prof. Dr. Luigi Uccioli

E-Mail Website
Guest Editor
Diabetic Foot Unit, Department Systems Medicine, University of Rome Tor Vergata, Rome, Italy
Interests: diabetic foot; diabetic foot ulcers; diabetic foot infections; diabetic foot osteomyelitis; diabetic symmetric polyneuropathy; peripheral atherial disease; charcot foot
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. José Luis Lázaro-Martínez

E-Mail Website
Guest Editor
Diabetic Foot Unit, Universidad Complutense de Madrid, Madrid, Spain
Interests: diabetic foot; diabetic foot ulcers; diabetic foot infections; diabetic foot osteomyelitis; diabetic symmetric polyneuropathy; charcot foot
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This is the third edition of the Special Issue “Diabetic Foot Complications: Current Challenges and Future Prospects”.

The previous two editions were quite successful, with a large number of manuscripts about different topics in diabetic foot diseases, including meta-analyses, systematic revisions, and novel studies about promising techniques that could improve diabetic foot management and lower limb ailments (https://www.mdpi.com/journal/jcm/special_issues/Diabetic_Foot_Complications_2, https://www.mdpi.com/journal/jcm/special_issues/Diabetic_Foot).

Diabetic foot is a growing complication due to the global rise in Diabetes mellitus prevalence, affecting 9.1 to 26.1 million people annually worldwide and between approximately 19% and 34% of people with diabetes at least once in their life. Diabetic foot is sometimes associated with lower limb amputations and higher rates of mortality than some kinds of cancer, such as breast cancer or prostate cancer. In recent years, evidence has been focused on the management of the main complications that lead patients to limb loss, such as diabetic foot infections or peripheral vascular disease. The majority of studies investigate outcomes over the acute phase when a patient has a complicated diabetic foot ulcer. However, long-term studies, randomized control trials, and studies on prevention, both primary and secondary, are still few in the literature. On the other hand, the benefits of a multidisciplinary team on patient outcomes, health care system organization, and the competences of different specialties and health care professionals and what the impact is of different organizational and structural approaches are not yet very well studied in the literature. With this Special Issue, we hope to encourage submissions that discuss the current state of the art, address ongoing knowledge gaps, and focus on ongoing controversies related to diabetic foot complications.

Prof. Dr. Luigi Uccioli
Prof. Dr. José Luis Lázaro-Martínez
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 100 words) can be sent to the Editorial Office for announcement on this website.

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-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly 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 2600 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 ulcers
  • diabetic foot infections
  • charcot foot
  • peripheral vascular disease
  • prevention diabetic foot
  • lower limb amputation
  • diabetic foot mortality
  • biomechanics of diabetic foot

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Related Special Issue

Published Papers (6 papers)

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Research

17 pages, 557 KiB  
Article
Social Support and Disease Acceptance in Patients with Diabetic Foot Syndrome and Their Relationship with the Metabolic Control of the Disease
by Ewa Kobos, Olga Serafin, Ewa Kostrzewa-Zabłocka and Anna Stefanowicz-Bielska
J. Clin. Med. 2025, 14(10), 3412; https://doi.org/10.3390/jcm14103412 - 13 May 2025
Viewed by 154
Abstract
Background: Diabetic foot syndrome (DFS) constitutes a serious clinical challenge in the treatment of diabetes. The aim of this study was to assess social support and acceptance of the disease in patients with diabetic foot syndrome and their relationship with the metabolic [...] Read more.
Background: Diabetic foot syndrome (DFS) constitutes a serious clinical challenge in the treatment of diabetes. The aim of this study was to assess social support and acceptance of the disease in patients with diabetic foot syndrome and their relationship with the metabolic control of diabetes. Methods: This was an observational, single-center study, conducted in 80 people hospitalized in the general and vascular surgery department. This study included adult patients with type 1 or type 2 diabetes, diagnosed with DFS. The mean age of the patients was 65.63 years, with the median age of 62 years. The youngest patient was 27, and the oldest was 94 years old. Men constituted 71.25% of the study group, women 28.75%. The following data were collected: the results of laboratory tests and measurements, the Acceptance of Illness Scale (AIS), and the Social Support Scale (S4-MAD) scores. Results: Abnormal values of non-high-density lipoprotein cholesterol (mean (M) = 120.76 mg/dL) and low-density lipoprotein cholesterol (M = 144.56) were shown in all the patients. Abnormal low-density lipoprotein values occurred in 98.75% of the patients (M = 148.21 mg/dL), and 83.75% of the participants had abnormal values of the systolic pressure (M = 145 mmHg) and total cholesterol. Glycated hemoglobin was abnormal in 61.25% of the subjects (M = 8.95%). The average score on the Acceptance of Illness Scale was 18.4 points in the study group. Out of the 100 possible points in the subscales of social support, the patients obtained an average of 46.5 points in the nutrition dimension, 40 for physical activity, 47.1 for glycemic self-control, 27.4 for foot care, and 68.9 for smoking. Conclusions: Patients with diabetic foot syndrome are characterized by poor acceptance of the disease and receive moderate social support. Patients receive the highest support in terms of cigarette smoking and glycemic self-control, with the lowest in foot care. The patient’s acceptance of the disease and the social support received are unrelated to the patient’s goals of disease control. Higher social support received by the DFS patients is associated with a greater acceptance of the disease. Full article
(This article belongs to the Special Issue Diabetic Foot Complications: Current Challenges and Future Prospects—3rd Edition)
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16 pages, 5835 KiB  
Article
Chronic Ulcers Healing Prediction through Machine Learning Approaches: Preliminary Results on Diabetic Foot Ulcers Case Study
by Elisabetta Spinazzola, Guillaume Picaud, Sara Becchi, Monica Pittarello, Elia Ricci, Marc Chaumont, Gérard Subsol, Fabio Pareschi, Luc Teot and Jacopo Secco
J. Clin. Med. 2025, 14(9), 2943; https://doi.org/10.3390/jcm14092943 - 24 Apr 2025
Viewed by 390
Abstract
Background: Chronic diabetic foot ulcers are a global health challenge, affecting approximately 18.6 million individuals each year. The timely and accurate prediction of wound healing paths is crucial for improving treatment outcomes and reducing complications. Methods: In this study, we apply predictive modeling [...] Read more.
Background: Chronic diabetic foot ulcers are a global health challenge, affecting approximately 18.6 million individuals each year. The timely and accurate prediction of wound healing paths is crucial for improving treatment outcomes and reducing complications. Methods: In this study, we apply predictive modeling to the case study of diabetic foot ulcers, analyzing and comparing multiple models based on Deep Neural Networks (DNNs) and Machine Learning (ML) algorithms to enhance wound prognosis and clinical decision making. Our approach leverages a dataset of 1766 diabetic foot wounds, each monitored for at least three visits, incorporating key clinical wound features such as WBP scores, wound area, depth, and tissue status. Results: Among the 12 models evaluated, the highest accuracy (80%) was achieved using a three-layer LSTM recurrent DNN trained on wound instances with four visits. The model performance was assessed through AUC (0.85), recall (0.80), precision (0.79), and F1-score (0.80). Our findings indicate that the wound depth and area at the first visit followed by the wound area and granulated tissue percentage at the second visit are the most influential factors in predicting the wound status. Conclusions: As future developments, we started building a weakly supervised semantic segmentation model that classifies wound tissues into necrosis, slough, and granulation, using tissue color proportions to further improve model performance. This research underscores the potential of predictive modeling in chronic wound management, specifically in the case of diabetic foot ulcers, offering a tool that can be seamlessly integrated into routine clinical practice. Full article
(This article belongs to the Special Issue Diabetic Foot Complications: Current Challenges and Future Prospects—3rd Edition)
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10 pages, 639 KiB  
Article
The Performance of Gram-Staining in Tailoring the Empirical Antibiotic Choice in Operated Diabetic Foot Infections
by Dominique Altmann, Jonas Liebe, Felix W. A. Waibel, Madlaina Schöni, Francesca Napoli, Christina Sydler, Fabian Schläfli, Linus Ledermann, Benjamin A. Lipsky and Ilker Uçkay
J. Clin. Med. 2025, 14(7), 2468; https://doi.org/10.3390/jcm14072468 - 4 Apr 2025
Viewed by 782
Abstract
Background/Objectives: Current international guidelines recommend choosing an empirical antibiotic regimen for treating diabetic foot infections (DFI) based largely on clinical severity of the infection and local microbiological epidemiology. This may lead to selecting unnecessarily broad-spectrum initial empiric antibiotic therapy. Methods: Using data from [...] Read more.
Background/Objectives: Current international guidelines recommend choosing an empirical antibiotic regimen for treating diabetic foot infections (DFI) based largely on clinical severity of the infection and local microbiological epidemiology. This may lead to selecting unnecessarily broad-spectrum initial empiric antibiotic therapy. Methods: Using data from our hospital in a large Swiss city, we retrospectively analyzed the performance of the Gram-stained smears of predominantly deep surgical DFI specimens processed by our microbiology laboratory in predicting the microorganism grown on standard cultures. We excluded episodes with paucibacillary stain results, which we interpret as contamination. Results: Among 1235 operated moderates or severe DFIs, Gram-stained smear was reported in 321 (26%) of cases, and showed bacteria in 172 episodes (54%) of these. Overall, among Gram stain results with organism seen, the sensitivity, specificity, accuracy, positive and negative predictive values of the Gram stain smear when compared with the cultures was 56%, 93%, 97%, and 38%, respectively. The accuracy was 73%. The corresponding statistical values specifically for Gram-negative bacteria were 61%, 97%, 50%, and 82%. Conclusions: The results of routine Gram stain smears of deep intraoperative DFI specimens generally lack sufficient sensitivity, and was only useful to reasonably exclude a DFI caused predominantly by Gram-negative bacteria. For Gram-stained smears results to be useful for guiding antibiotic stewardship, we need prospective trials to assess their value in different types of DFIs. Full article
(This article belongs to the Special Issue Diabetic Foot Complications: Current Challenges and Future Prospects—3rd Edition)
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15 pages, 559 KiB  
Article
The Burden of Diabetic Foot Ulcers on Hospital Admissions and Costs in Romania
by Adriana Rusu, Gabriela Roman, Bogdan Stancu and Cornelia Bala
J. Clin. Med. 2025, 14(4), 1248; https://doi.org/10.3390/jcm14041248 - 13 Feb 2025
Viewed by 713
Abstract
Background/Objectives: Diabetic foot ulcers represent an important economic burden for healthcare systems worldwide. We aimed to analyze the costs of care for diabetic foot ulcers (DFUs) associated with peripheral neuropathy (DPN) and peripheral arterial disease (PAD) and their trends in a tertiary-care [...] Read more.
Background/Objectives: Diabetic foot ulcers represent an important economic burden for healthcare systems worldwide. We aimed to analyze the costs of care for diabetic foot ulcers (DFUs) associated with peripheral neuropathy (DPN) and peripheral arterial disease (PAD) and their trends in a tertiary-care hospital. Methods: We used data from the electronic system of the Emergency Clinical County Hospital Cluj-Napoca, Romania. We included all episodes of hospitalization with a discharge date between 1 January 2015 and the 31 December 2018 and a discharge diagnosis of type 1 or type 2 diabetes, DPN, PAD, and foot ulcers. Results: During the analyzed period, 1094 episodes of hospitalization with type 1 or type 2 diabetes and DFUs were recorded. Of these, 25.9% had neuropathic, 47.1% ischemic, and 16.6% neuroischemic DFUs. The median length of hospital stay was 8.0 days, and the median cost per episode of hospitalization was 810.8 EUR, with no significant variations during the analyzed years. The cost per episode of hospitalization was higher in cases with ischemic DFUs than for other etiologies of foot ulcers for 2015–2017 (p < 0.001). In 2018, the costs for ischemic and neuroischemic DFUs were similar and significantly higher compared to neuropathic ones. Predictors of higher costs per episode of hospitalization included the etiology of the DFUs (β = 0.032, p = 0.034) and the length of hospital stay (β = 0.860, p < 0.001). Conclusions: By analyzing data from a tertiary care hospital, we showed higher costs for the care of persons with ischemic DFU. Full article
(This article belongs to the Special Issue Diabetic Foot Complications: Current Challenges and Future Prospects—3rd Edition)
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12 pages, 1201 KiB  
Article
The Appropriateness of Footwear in Diabetic Patients Observed during a Podiatric Examination: A Prospective Observational Study
by Anisa Hazbiu, Ilaria Teobaldi, Mario Sepe, Giovanni Federici, Marco Meloni and Luigi Uccioli
J. Clin. Med. 2024, 13(8), 2402; https://doi.org/10.3390/jcm13082402 - 20 Apr 2024
Viewed by 1986
Abstract
Background: Adequate compliance with wearing therapeutic footwear (TF) to prevent diabetic foot ulcers is known to be low. The primary aim of this study was to identify population awareness about the ulceration and/or recurrence risk according to footwear choice. The secondary aim was [...] Read more.
Background: Adequate compliance with wearing therapeutic footwear (TF) to prevent diabetic foot ulcers is known to be low. The primary aim of this study was to identify population awareness about the ulceration and/or recurrence risk according to footwear choice. The secondary aim was to evaluate the compliance level in footwear choice based on a patient’s own risk. Methods: Forty podiatrists participated from 1 September 2017 to 31 August 2018, providing six-section forms which included personal data, risk classification, footwear characteristics and a knowledge questionnaire. Results: This study included 1507 patients. Those with active ulcers were excluded. A total of 43% of patients belonged to risk class 0, 19% to risk class 1, 19% to risk class 2 and 19% to risk class 3. A total of 58% had foot deformities. Conclusions: Nearly half of patients with a high risk of ulceration had knowledge of their own risk but the majority of them did not follow the recommendations. Only a small percentage (36%) of risk class 3 patients wore footwear suitable for their risk class. There was poor consideration of footwear choice among patients. We highlight critical issues in patient education and compliance with wearing footwear appropriate to their risk class. Full article
(This article belongs to the Special Issue Diabetic Foot Complications: Current Challenges and Future Prospects—3rd Edition)
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9 pages, 431 KiB  
Article
Diagnostic Performance of Atherogenic Index of Plasma for Predicting Diabetic Foot Osteomyelitis with Peripheral Artery Disease
by Sebastián Flores-Escobar, Mateo López-Moral, Marta García-Madrid, Francisco J. Álvaro-Afonso, Aroa Tardáguila-García and José Luis Lázaro-Martínez
J. Clin. Med. 2024, 13(7), 1934; https://doi.org/10.3390/jcm13071934 - 27 Mar 2024
Cited by 1 | Viewed by 1376
Abstract
Background: This study aims to assess the atherogenic index of plasma (AIP) diagnostic value in detecting diabetic foot osteomyelitis (DFO) among patients with diabetic foot ulcers (DFUs). Methods: A prospective cohort study was conducted on 80 patients with DFUs and suspected DFO between [...] Read more.
Background: This study aims to assess the atherogenic index of plasma (AIP) diagnostic value in detecting diabetic foot osteomyelitis (DFO) among patients with diabetic foot ulcers (DFUs). Methods: A prospective cohort study was conducted on 80 patients with DFUs and suspected DFO between January 2022 and December 2023. The primary outcome measures included the diagnosis of DFO, determined by positive microbiological analysis results from bone samples and its correlation with the AIP. Receiver operating characteristic (ROC) curves were utilized to select the optimal diagnostic cut-off points for AIP and post hoc analysis was performed to evaluate the difference in the AIP for diagnosing DFO in patients with and without peripheral arterial disease (PAD). Results: The diagnostic potential for DFO in PAD patients of AIP-1 (Log TC/HDL) showed an AUC of 0.914 (p < 0.001 [0.832–0.996]), leading to a sensitivity of 83% and a specificity of 85%. By contrast, AIP-2 (Log TG/HDL) demonstrated a slightly lower AUC of 0.841 (p < 0.001 [0.716–0.967]), leading to a sensitivity of 76% and a specificity of 74%. Conclusions: The AIP tool, with its ideal blend of sensitivity and specificity, aids in predicting DFO effectively. Therefore, clinicians should consider using AIP for patients suffering from PAD and associated DFO. Full article
(This article belongs to the Special Issue Diabetic Foot Complications: Current Challenges and Future Prospects—3rd Edition)
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