Diabetic Foot Disease: Current Challenges, Emerging Concepts and Future Directions

Topic Information

Dear Colleagues,

Diabetic foot disease remains one of the most devastating and costly complications of diabetes mellitus, affecting millions of people worldwide each year. It is estimated that between 19% and 34% of individuals with diabetes will develop a foot ulcer during their lifetime, with 9 to 26 million new cases occurring annually. Despite advances in care, diabetic foot complications continue to be associated with major lower limb amputation, reduced quality of life, substantial healthcare costs, and mortality rates that rival or exceed those of several common cancers.

Over the last decade, research has predominantly focused on the acute management of complicated diabetic foot ulcers, particularly infection and peripheral artery disease. However, critical gaps persist. There is a clear need for high-quality long-term studies, robust randomized controlled trials, real-world data analyses, and research addressing primary and secondary prevention, recurrence, and readmission.

Furthermore, although multidisciplinary care models are widely recommended, the impact of different organizational structures, healthcare pathways, professional competencies, and system-level strategies on patient outcomes remains insufficiently explored.

This Topic aims to bring together cutting-edge research that advances the field beyond acute management and addresses the broader clinical, translational, and health system challenges of diabetic foot disease. We particularly welcome submissions on the following:

• Prevention strategies (primary and secondary);
• Recurrence and long-term outcomes;
• Innovative diagnostics and therapeutics;
• Multidisciplinary care models and healthcare organization;
• Cost-effectiveness and health economics;
• Implementation science and real-world evidence;
• Controversies and emerging paradigms in diabetic foot management.

By fostering rigorous scientific discussion and multidisciplinary perspectives, this Topic seeks to contribute to improved patient outcomes and more sustainable healthcare systems.

We warmly invite researchers and clinicians worldwide to submit their work and be part of this important initiative.

Prof. Dr. José Luis Lázaro-Martínez
Dr. Marco Meloni
Dr. Prashanth Vas
Topic Editors

Keywords

Participating Journals

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Antibiotics antibiotics	4.6	8.7	2012	16.4 Days	CHF 2900	Submit
Diabetology diabetology	2.2	3.7	2020	24.4 Days	CHF 1400	Submit
Journal of Clinical Medicine jcm	2.9	5.2	2012	18.5 Days	CHF 2600	Submit
Journal of the American Podiatric Medical Association japma	0.6	1.4	1907	15.0 days *	CHF 1200	Submit
Medicina medicina	2.4	4.1	1920	17.5 Days	CHF 2200	Submit

* Median value for all MDPI journals in the second half of 2025.

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Published Papers (1 paper)

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All Antibiotics Diabetology JAPMA JCM Medicina

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18 pages, 3928 KB  

Open AccessArticle

Evaluating the Tissue Optical Perfusion Pressure Method in Diabetic Patients with and Without Media Arterial Calcification

by Igli Kalaja, Max Maria Meertens, Volker Hubert Schmitt, Birgit Linnemann, Gerhard Weißer, Melanie Schwaderlapp, Sarah Schneider, Leoni Hoffmann and Christine Espinola-Klein

J. Clin. Med. 2026, 15(10), 3891; https://doi.org/10.3390/jcm15103891 - 18 May 2026

Viewed by 193

Abstract

Background: The ankle-brachial index (ABI) is a popular method for evaluating peripheral artery disease (PAD). However, it is unreliable in patients with diabetes mellitus (DM), particularly in cases of media arterial calcification (MAC), where falsely elevated or unreliable values may be produced. [...] Read more.

Background: The ankle-brachial index (ABI) is a popular method for evaluating peripheral artery disease (PAD). However, it is unreliable in patients with diabetes mellitus (DM), particularly in cases of media arterial calcification (MAC), where falsely elevated or unreliable values may be produced. The toe-brachial index (TBI) is therefore recommended in such cases, but has its limitations. The tissue optical perfusion pressure (TOPP) method is another automated diagnostic protocol combining oscillometric ABI measurement (oABI) and photo-plethysmographic pulse-wave assessment using the pulse wave index (PWI). The study evaluated TOPP-derived parameters in diabetic patients with or without MAC, in comparison with established functional vascular examinations. Methods: PAD patients with DM presenting in our outpatient clinic were enrolled prospectively from January to August 2024. Patients with peripheral bypasses or deemed unsuitable for the TOPP method were excluded. All patients received an ABI, TBI and TOPP measurement. Results: A total of 107 patients with DM were included in the present study. 38 patients presented with MAC and 69 patients without. The majority were male. Most patients presented with claudication (20 Fontaine stage IIa, 30 stage IIb), 9 presented with rest pain (Fontaine stage III), and 31 with wounds (Fontaine stage IV). 17 patients were free of symptoms (Fontaine stage I). The two parameters of the TOPP method, oABI and PWI, both correlated with the TBI and ABI. In patients with MAC, the oABI did not correlate with any other measurement, but the PWI did weakly correlate with the TBI. MAC is an important factor in influencing measurement accuracy. Despite their limitations, the TBI showed a significant correlation to the clinical symptoms (correlation coefficient = −0.387, p < 0.001). Conclusions: In patients without MAC, oABI and PWI correlated with ABI and TBI. TBI was the most reliable parameter in those with MAC. PWI correlated with TBI, but the correlation was weak. TBI should not be replaced by PWI. PWI may provide complementary information in a diagnostic protocol. oABI did not correlate with clinical symptom severity in DM patients, independently of the presence of MAC, and is unsuitable as a stand-alone parameter. A combination of TBI and TOPP-derived parameters may help to assess the severity of peripheral artery disease in diabetic patients with MAC. Larger multicentre studies are required. Full article

(This article belongs to the Topic Diabetic Foot Disease: Current Challenges, Emerging Concepts and Future Directions)

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