Diabetic foot prevention, assessment, and management using innovative smart wearable technology: a systematic review

The diabetic foot (DF) is a chief culprit behind significant preventable morbidity and mortality in type-2-diabetes patients and the leading cause of non-traumatic lower-extremity amputations. Despite the clinically well-understood pathways to ulceration, including neuropathy, ischemia, and infection, DF continues to impose a significant health and economic burden on patients and healthcare systems. Recent technological developments in sensing, smart miniaturized wearable technology, and artificial intelligence provide ample options for viable solutions. A continuous monitoring wearable system that alerts patients and healthcare providers could enhance current detection and management protocols. Quantification of both mechanical (plantar-pressure and shear-forces) and physiological/wound-associated parameters (temperature, humidity, vascular, microcirculation, and pH) underlying the pathophysiology of DF provides opportunities for improving the assessment of DF and treatment outcomes. This review bridges this knowledge gap by exploring the integration of current state-of-the-art sensing modalities and smart wearables with novel actuation technology for real-time management towards effective wound healing of the DF.