Epidemiology, pathophysiology, and management of diabetic foot: A comprehensive review

BACKGROUND: Diabetic foot ulcers (DFUs) represent one of the most debilitating and costly complications of diabetes mellitus, leading to substantial morbidity, mortality, and healthcare burden. Their global incidence continues to rise in parallel with the increasing prevalence of diabetes and aging populations. OBJECTIVE: To critically review the epidemiology, pathophysiological pathways, and contemporary management strategies of diabetic foot, with emphasis on translational advances and emerging therapeutic directions. METHODS: A systematic literature search was conducted utilising the PubMed, Scopus, and Web of Science databases for publications from 2015 to 2025 employing the terms 'diabetic foot ulcer,' 'management,' 'therapy,' 'regeneration,' and 'emerging treatment.' Only studies published in English that concentrate on clinical or translational advancements in diabetic foot care were included. Reviews, case reports, and irrelevant articles were omitted. Following the evaluation of 286 records, 132 studies were selected for synthesis. RESULTS: Chronic hyperglycemia drives neuropathy, vasculopathy, and persistent inflammation, impairing the normal wound healing cascade. Standard management-including glycemic control, debridement, infection management, pressure offloading, and advanced dressings-remains essential. However, novel therapies such as bioengineered skin scaffolds, recombinant growth factors, stem cell applications, nanotechnology-based delivery systems, and negative-pressure wound therapy are transforming the field. Despite technological promise, widespread implementation remains challenged by regulatory and economic constraints. CONCLUSION: The future of diabetic foot care lies in multidisciplinary, precision-based paradigms integrating smart biomaterials, gene therapy, artificial intelligence, and telemedicine. These convergent technologies hold the potential to revolutionize wound healing outcomes and reduce the global burden of diabetic complications.